Method and apparatus for recording spatial gingival soft tissue relationship to implant placement within alveolar bone for immediate-implant placement

ABSTRACT

A dental implant has a hollow shell with outer bio-compatible surface for engaging a soft tissue socket left in gingival tissue after a tooth has been extracted, to promote healing. The shell tapers outwardly from a first to a second perimeter, the second perimeter being asymmetrically scalloped with opposite distal and mesial peaks and opposite lingual and facial valleys between the peaks. A dental implant in the bone socket left after tooth extraction is rigidly connected to a temporary post, the temporary post extending in the shell. The shell engages against the soft tissue socket without gaps and without requiring alignment between the shell and implant axes.

CROSS-REFERENCE TO RELATED APPLICATION

This is a continuation-in-part of application Ser. No. 13/356,359 filedJan. 23, 2012 which is incorporated herein by reference.

FIELD AND BACKGROUND OF THE INVENTION

The present invention relates generally to the field of dental implantsand, in particular, to new and useful soft tissue preservation abutmentarrangement and method with immediate implant placement. The inventionrelates generally to the ability to record the spatial relationship ofthe residual soft tissue socket of an extraction site, to the positionof an immediate implant placed within the alveolar bone without directcontact of the structures. The invention relates generally to recordingthe individual shape and position of the residual soft tissue socket andhow it relates to other structures prior to removal of the tooth, namelythe shape and position of the clinical crown of the extracted tooth andthe occlusal contact of the opposing and adjacent teeth.

General Considerations and Problems to Overcome:

The tooth is a structure of the oral cavity which is vital to thecapability of chewing and important to the general well-being andappearance of people. Anatomically, the tooth resides within the oralcavity, firmly anchored within the upper and lower jaws (maxilla andmandible). Human teeth reside within two distinct anatomic regions ofthe jaws; the apical inferior portion of the tooth (the root) isconnected to the jaw via an attachment called the periodontal ligament.We will here define this portion of the tooth that is connected to thebone as the “bone-zone” or hard tissue zone of the tooth. Second, thesuperior portion of the tooth (the anatomic crown) is connected to thejaw in the soft tissue or gingival region of the jaw defined as the“tissue-zone” or soft tissue zone. The anatomic crown is demarcated, asthat portion of the tooth superior to crest of bone and it will includea small portion of the root superior to the crest of bone as well as theclinical crown that is visible. The tissue-zone forms a soft tissuecollar around the neck of a tooth. This tissue-zone connection (i.e.soft tissue to tooth attachment) is composed of gingival fibers thatinsert into the superior aspect of the root surface; specifically,hemidesmosmal cell attachment to the root and crown forming a biologicaladhesion of the sulcular epithelium (gingival tissues) to the surface ofa tooth.

The tissue-zone connection plays a critical role in maintaining healthof the oral cavity. It does this by preventing the ingress of microbesand foreign substances into the body by providing a “biologic-seal” atthe interface of the tooth-jaw connection at the tissue-zone. Thisfunctional attachment of the soft tissue to the surface of the toothshould be fully appreciated as a critical defense barrier. As withoutthe presence of this soft tissue biologic seal the underlying bone wouldbe vulnerable to numerous invasions of various foreign substances.

In addition, the tissue-zone plays an essential role in maintaining andpreserving the dental esthetics of the smile. This same tissue-zonerepresents the peaks (papillae) and valleys of the soft tissue gingivalthat surround the neck of each and every tooth. It is the spatialrelationship of tooth form and color with healthy soft tissue gingivalarchitecture that are known as the essential building blocks of dentalesthetics as we know it. Experts of dental esthetics have called thesoft tissue gingiva “the frame” of the picture, and regard the teeth asthe “subject matter” of that painting. Disregarding the frame of apainting would certainly impact the overall esthetic appearance beingviewed, and the same is true with respect to the gums and teeth. Theloss or the alternation of anatomic structures of the tissue-zone hasbeen shown to lead to an inferior esthetic outcome in addition tocausing a potential risk of disease for the patient.

The tooth and its attachment to the jaw is subject to numerous pathogensover the lifetime of a patient, particularly due to trauma/fracture,endodontic failure, decay, localized periodontal disease, etc. Any ofthese conditions can lead to the eventual need for removal of either asingle tooth or multiple teeth. The removal or extraction of a tooth orteeth will result in a radical morphologic change to the anatomy as wellas the potential exposure of the internal tissues (connective tissuesand underlying organs) of the body to invasion by foreign substances.

The extraction of a tooth results in a cascade of changes depending onhow this procedure is performed. Tooth removal in the past has been ahighly traumatic surgical procedure. It was not uncommon for an oralsurgeon to fully reflect the gingival tissues as a surgical flap toexpose the underlying tooth and bone to aid in the ease of access andvisualization of the tooth to be removed. It is during this surgicalreflection of the gingival soft tissues that the normal anatomy of thetissue-zone would be radically altered and permanently changed.Destruction of the normal architecture of the gingiva occurs as surgicalinstruments were used to cut, tear, crush and rip the attachment fibersbetween the tooth and soft tissues of the tissue-zone. In accordancewith gingival surgical flap surgery, closure of a surgical flap isaccomplished with the placement of sutures to close the wound created.Primary (or complete) flap closure is highly desirable to ensure there-establishment of a biologic-seal of the soft tissue to preventingressof foreign bodies to the host.

Gingival flap surgery also has the known deficiency to result in boneloss from the stripping away of the periosteum and hence the bloodsupply to the bone during the reflection of a surgical flap. It is welldocumented in the dental literature that gingival surgical flaps resultin bone loss by the exposure of the underlying bone. Dr. Lindhe andco-workers have scientifically demonstrated that surgical flap elevationand removal of teeth leads to loss of the residual bone and the shape ofremaining ridge after tooth removal. These undesirable anatomic changesto the bone make the placement of implants more complex and increasesrisk for patients.

For the reasons identified above, the trend toward minimally invasivesurgical procedures has been developed toward the extraction of teeth.Examples of these changes include the use of micro-surgical instruments,periotomes and extraction forceps that do not require the reflection ofa surgical flap to remove teeth. Ultrasonic (piezo technology) surgicalinstruments, dental lasers and rotary devices have been suggested asmechanisms to minimize trauma during the removal of teeth. It isgenerally accepted within the profession that a minimally invasivetechnique for tooth removal should be the standard of care.

In an attempt to minimize detrimental anatomic changes during thesurgical removal of a tooth, a major effort is now underway to preservethe bone-zone and tissue-zone after tooth removal. The objective of thedental profession to preserve bone was a natural extension of a vastbody of knowledge recently created on periodontal bone regeneration viathe use of bone replacement substances. Examples of such efforts includeautografts, allografts, xenografts and a variety of bone replacementmaterials that include; Bone Morphogenic Proteins (BMP's), Stem CellDerivatives, Platelet Rich Proteins (PRP's) derived from the blood andnumerous other biologic sources. Bone regeneration after periodontaldisease is well established in the prior art. A deficiency of using bonereplacement substances is the inability to contain and protect thesematerials to exposure to the oral cavity during the critical healingphase, i.e. a fundamental inability to re-establish the all-importantbiologic-seal of the Tissue-Zone once a tooth is removed.

The use of barrier membranes for guided tissue bone regeneration (GTR)is a known attempt to preserve and regenerate lost bone afterperiodontal disease. The use of membranes has more recently been appliedto the regeneration and preservation of bone after tooth removal.Barrier membranes assist in creating a protective barricade to thebone-zone by excluding unwanted cells (connective tissue cells) from thehealing site. This is an attempt to allow the body to more effectivelyrefill a residual bony socket with bone cells (a.k.a. osteoblasts) knownto be critical for bone growth. A general deficiency of using barriermembranes is the direct exposure of a barrier membrane that consequentlylends to the inability to establish a soft tissue seal. The exposure ofthe barrier membrane leads to plaque accumulation on the surface of themembrane that is impossible to clean. Once membranes become exposed tothe oral environment, bacteria colonization on the surface of themembrane quickly spearheads an infection and/or failure of regenerationof bone. The primary cause of the exposure of the membrane is a lack ofa soft tissue biologic-seal after gingival flap surgery. The inabilityto re-establish a biologic-seal after the removal of a tooth has manyrepercussions to bone and soft tissue regeneration.

A general deficiency of the fresh extraction site is the ability torelate the position of the overlying residual soft tissue to an implantplaced immediately into a fresh bony extraction site. The root socketwill often dictate where and how the implant will be placed. An anglenaturally exists between the clinical crown and the root of a toothranging from 5 to 28 degrees in a buccal-lingual direction. Teeth arealso known to have a medial or distal tip of the root within the rangeof 2 to 17 degrees in a properly aligned dentition according to theKraus, Jordan and Abrams Dental Anatomy and Occlusion textbook. SeeKraus B, Jordan R, Abrams L., Dental Anatomy and Occlusion, WaverlyPress, Inc. Baltimore, Md. 1980. Teeth are often mal-aligned prior toremoval and may therefore have root positions with greater angles thenthose previously mentioned. It is therefore not uncommon that the rootsof these teeth would require an immediate implant to be positioned witha significant angulation to the ideal axial position resulting in anangulated post-implant placement. Additionally, the ability to controlthe vertical, horizontal and transverse positioning of an implant by theoperator during immediate implant placement into an extraction site canbe difficult as it is often dictated by the remaining bone availability.Bone morphology related to the overlying gingival tissues are consideredindependent anatomic structures in which the shape and position of onedoes not dictate the other. This finding is why pre-treatment dentalCT-scans are considered the standard of diagnostic care for implantplacement. Therefore the location of an immediate implant placed withina fresh extraction site is typically not positioned concentric to theposition of the overlying residual soft tissue gingival socket opening.There is typically a discrepancy between the vertical, horizontal andtransverse positions of the opening of the soft tissue gingival socketand the axial position of the immediate dental implant so much so thatcurrent available implant components are ineffective.

A general deficiency of being able to relate the spatial position of theresidual soft tissue gingival socket complicates the ability tofabricate a dental prosthesis from prefabricated “stock” components. Theneed to utilize customized components to compensate for the disharmonyis important to recognize. The independent spatial relationship of theunderlying bone (or dental implant) to the overlying gingival tissuesbecomes difficult or impossible to relate to one another once the toothis removed. To overcome these discrepancies, the invention will describea method and device to accurately record the three-dimensional positionof the soft tissue gingival socket after a tooth has been removed. Itwill also describe a method to relate this soft tissue gingival socketto a dental implant placed within the alveolar bone of an immediateextraction/implant surgical placement procedure. Additionally, theinvention will describe means to relate the residual soft tissue socketof the gingiva to the position of the extracted clinical crown prior toremoval and the occlusal contacts of that crown to the adjacent teeth aswell as the opposing teeth, prior to removal. All of the definedrelationships are critical to enable the successful fabrication of adental implant prosthesis.

Loss of the biologic-seal of the tissue-zone also has a significantimpact on soft tissue changes to both the macro- and micro-anatomy ofthe gingiva. It is accepted in the dental literature that the loss ofgingival attachment within the tissue-zone leads to the irreversibleloss of the interdental papillae and the gingival architecturesurrounding a tooth. There are currently no predictable surgicaltechniques available to correct the gingival changes to vertical heightand horizontal dimensional after tooth removal. Much effort has beendirected toward preserving the bone after tooth removal but far lesseffort has been applied to preserving the macro- and micro-anatomy ofthe tissue-zone after tooth removal.

As will be explained more fully in the following, the method andarrangement of the present invention are effective means to preserve theesthetic and anatomic architecture of the tissue-zone after toothremoval and to relate and record the spatial relationship of thispreserved soft tissue socket to the immediate placement of a dentalimplant. Furthermore, the invention relates the residual soft tissuesocket to the position and shape of the extracted tooth as well as theadjacent and opposing teeth.

The understanding of using a minimally invasive technique as well asre-establishing a biologic-seal after tooth removal has been discussedbut has not yet been made possible in all cases by known methods andapparatuses. In addition to these important concepts one further conceptrelated to tooth removal is the technique of immediate dental implantplacement after the extraction of a tooth/teeth and the ability torelate the anatomic and dental implant structures to one another and tothe surrounding teeth.

The replacement of a tooth by a dental implant device is well known inthe prior art. It is understood that there are two basic components tothe dental implant device; the root-form component held within thebone-zone commonly referred to as the “dental implant” and a secondcomponent, the implant anatomic crown composed of an abutment andclinical crown. Both the abutment and clinical crown are typicallyplaced superior to the crest of bone therefore within and superior tothe tissue-zone. An implant prosthesis was first described as a surgicalmethod and device that used a fully submerged, non-loaded healing periodprior to the connection of the dental implant crown.

The advent of contemporary implant dentistry was first described byProf. P. I. Branemark in the late 1970's and established the use of atitanium root-form screw to be inserted into the bone placed by using anatraumatic surgical technique described by this researcher/inventor. Themethod described by Branemark discussed the placement of the dentalimplant into jawbone of a fully edentulous ridge. He described a methodin which the implant would be fully submerged and non-loaded during ahealing period of 4-6 months after the dental implant was placed andcovered within the bone. Pre-operative conditions therefore required afully healed ridge in which teeth were previously removed. The method ofusing a submerged, non-loaded healing period for dental implants remainsan approach still widely utilized today.

However, over the past 30 years alternative methods to implant placementhave occurred. The following are different methods that have beenadvocated to the non-submerged, non-loaded implant healing technique.

Advantages and disadvantages will be briefly discussed for eachtechnique.

Delayed, Submerged, Non-loaded Implant Placement Method:

Defined as the method for placing a root-form dental implant into thejawbone. The implant is placed within the bone-zone initially. Thepre-operative condition requires an edentulous ridge. The techniquedescribes the placement of the implant into the bone at or below thecrest of bone and it is fully covered by primary flap closure. Aninitial healing for a period of 4 to 6 months is required. A secondsurgery is required to expose the root-form implant and to connect ahealing abutment. Second healing period of 2-3 months is required forsoft tissue. Final crown delivery occurs approximately 9 months afterthe start of treatment.

Deficiencies of this Prior Art Method:

1. Multiple surgeries prior to implant crown placement are required.

2. Requires an edentulous ridge prior to implant placement into thebone-zone resulting in the irreversible changes to the soft tissues ofthe tissue-zone.

3. Difficult to re-establish a biologic-seal after numerous surgeriesand the connection of the implant crown.

4. Increased cost because of multiple surgeries and prostheticcomponents.

5. Inability to retain the pre-existing soft tissue anatomy prior totooth removal soft tissue healing results in undesirable changes to theoverlying gingival tissues that result in dramatic changes and/orreduction in the height and shape of the interdental papilla. Thesechanges lead to open contacts, open embrasures and affect the finaldental implant prosthesis. The resulting open spaces collect food,dental plaque and calculus and put the patient at greater risk to losingadditional teeth in the future.

6. An inability to maintain and record the position of the pre-treatmentsoft tissue gingival anatomy found prior to tooth removal to theunderlying alveolar bone and after a tooth has been removed. Thispositioning of a dental implant is dictated by bone availability with afailure to be able to relate the position of the dental implant to idealpre-treatment gingival tissues. The delayed approach makes it impossibleto position the dental implant relative to vertical, horizontal andtransverse, i.e. X, Y, Z axes of the soft tissue opening prior to toothremoval.

Delayed, Non-Submerged, Non-Loaded Implant Placement Method:

Defined as the method for placing a root-form dental implant into thejawbone exemplified by the Straumann, ITI implant company. The implantis placed within the bone-zone initially. The pre-operative conditionrequires an edentulous ridge. The technique describes the placement ofthe implant into the bone at or below the crest of bone or within thetissue-zone. A transmucosal healing cap component is used. A healingabutment or “cap” is placed onto the implant that is in direct contactwith the soft tissue during the initial bone-healing period of 4 to 6months. A second surgery is not required to expose the root-formimplant. Reformation of the tissue-zone is required. A connectionbetween the implant and the healing abutment is within the tissue-zone.

Deficiencies of this Prior Art Method:

1. Requires an edentulous ridge prior to implant placement into the boneresulting in the irreversible changes to the soft tissues of theTissue-Zone.

2. Requires flap surgery to place dental implant

3. Difficult to re-establish a biologic-seal after surgery and theconnection of the implant crown.

4. Difficult to re-establish soft tissue anatomy to the state it wasprior to tooth removal.

5. Healing abutment has a connection interface within the Tissue-Zone,which allows bacteria to adhere impeding wound healing.

6. Increased cost because of multiple components.

7. Loss of the natural anatomic gingival contours after healing of theextraction socket making it difficult if not impossible to identify andrecord the spatial position of the residual soft tissue gingival to theposition of the underlying bone and/or dental implant.

Immediate Root-Form Implant Placement:

A recent trend in implant dentistry that has occurred, that overcomesthe deficiency of requiring multiple surgeries, is the immediateplacement of a root-form dental implant directly into an extractionsocket after tooth removal.

This method deviates from the original protocols established byBranemark and co-workers. The advantage to the simultaneous placement ofa root-form dental implant after tooth removal is the reduction of thenumber of clinical procedures required as well as decreased treatmenttime. This technique eliminates the need to have the bone ridge healedafter tooth removal consequently requiring fewer surgical procedures.

Immediate implant placement requires a mechanical locking of theroot-form dental implant into the residual socket-site after a tooth hasbeen removed. Mechanical locking refers to the root-form implantengaging undisturbed bone in an attempt to provide primary mechanicalstability of the implant within the extraction socket. Immediate implantplacement is highly desirable in comparison to delayed implant placementsince it allows the immediate replacement of the tooth at asubstantially reduced amount of time when compared to previous method ofdelayed implant healing.

Immediate implant placement also requires the positioning of a root-formimplant to be located into the residual bone socket dictated by theprevious position of the root of the tooth. As previously described theroot of a tooth has a naturally occurring angle formed between the rootaxis and of the crown axis of a tooth. There are angles in twoorthogonal planes, the anterior-posterior and transverse, the angleranges from 5 to 28 degrees in a buccal-lingual direction and 2 to 17degrees in the mesial-distal direction for tooth/teeth in an idealposition. Frequently roots are found to be mal-aligned resulting insignificant deviations to the norm. An extracted root anatomy can havean atypical root form that can be curved, bent or positioned in anunusual location within the bone and the adjacent roots of teeth.Therefore, more often then not the root of a tooth is not axiallycentric to the clinical crown of a given tooth. Additionally the root ofa tooth is not positioned centrically between the two adjacent teeth ofthe extraction site. In fact more often then not the angulation of theroot socket and the soft tissue socket are difficult to align.Therefore, the immediate dental implant is typically not centricallylocated in relation to the opening of the residual soft tissue socket orthe adjacent teeth and roots. Compounding this deficiency is thedifficulty of vertical positioning of the immediate dental implant as itis related to the residual soft tissue socket. Vertical discrepancies inposition make the positioning of current components difficult if notimpossible to use at times since they cannot relate the soft tissueanatomy of the residual soft tissue socket effectively since theirshapes and orientations were not designed for the immediate soft tissuesocket.

Immediate Implant Placement Presents Numerous Risks and Deficiencieswith Current Methods Used:

1. An inability to fully engage the entire remaining socket surfaceafter tooth removal, thereby leaving a space (gap) between the surfaceof the implant and the surface of the remaining bone.

2. An inability to establish a biologic-seal to the overlying softtissues after a tooth has been removed.

3. An inability to retain bone regenerative materials if a residual gapremains between the surface of the implant and the bone socket.

4. An inability to establish a biologic-seal of the soft tissue over abarrier membrane to protect and contain bone regeneration materials andthe blood clot.

5. Inability to preserve the soft tissue architecture of the gingival ofthe Tissue-Zone.

6. Inability to compensate for the vertical, horizontal and transversediscrepancy between the positions of the immediate dental implant inrelation to the overlying soft tissue gingival socket after toothremoval.

7. Inability to relate the position and anatomy of the residual softtissue socket to the clinical crown of the extracted tooth and therelative position that the soft tissue socket has to the adjacent andopposing teeth.

8. Inability to record the peaks and valleys of the residual soft-tissuegingival socket as current abutment designs that are not designed tomimic the residual soft tissue socket but are circular in design.

The deficiencies of achieving a predictable and esthetic long termoutcome when using an immediate implant placement protocol can all bedirectly attributed to the inability to establish an acceptable biologicadaptation to create an effective biologic-seal in the tissue-zone ofthe remaining soft tissue socket after removal of a tooth.

The deficiencies of achieving a predictable and long term estheticoutcome of the final implant prosthesis associated with an immediateimplant placement protocol can all be directly attributed to theinability to accurately record the spatial relationship of the overlyingsoft tissue gingival socket to the underlying dental implant. Thisnon-concentric relationship makes it difficult if not impossible toutilize pre-fabricated stock dental implant abutments in all situationswhen working with immediate implant placement into a fresh toothextraction site. Current designs of dental implant abutments are twopiece components that require a central hole access for the position ofthe retaining screw which limits the position of these abutmentsrelative to the dental implant. Current dental implant abutment designswhich are anatomic are based on the root anatomy and do not take intoaccount the shape of the residual soft tissue socket topography with apeak and valley gingival margin, hence positioning, maintaining andrecording the residual soft tissue socket anatomy is difficult if notimpossible with the current “anatomic root form designs” of dentalimplant abutments. Additionally, lack of an ability to record thespatial relationship of the tissue-zone (trans-gingival zone) of thesoft tissue socket to the adjacent teeth and opposing arch make itdifficult if not impossible to pre-fabricated stock dental implantabutments.

The tissue-zone, i.e. the residual soft tissue gingival socket,represents the critical transition zone between an immediate dentalimplant and what will be the shape and position of the final implantcrown prosthesis. This unique transition zone must compensate for thespatial position of the implant contained in bone and the implant crownin the oral cavity. The tissue-zone (trans-gingival zone) of the gingivamust be considered an independent anatomic structure when compared tothe root-form implant and to the position of the clinical crown.Compensation of positioning can only be achieved if the components usedto record this structure are independent from both the root-form implantand the clinical crown of the implant prosthesis owning to the naturaland avoidable occurring vertical, horizontal and transversediscrepancies.

Immediate implant placement of a root-form dental implant has been shownto effectively osseointegrate by numerous authors (reference includedherein). The residual gap that is present between the implant surfaceand the bone surface requires careful management whether a surgical flapis performed or a non-flapless minimally invasive extraction techniqueis used. In either of these two approaches, irreversible soft tissuechanges have been shown to occur with immediate implant placement aftertooth removal. Changes within the tissue-zone are shown to occur asearly as 2-3 days after the immediate implant placement.

Other Prior Art:

U.S. Pat. No. 5,417,568 to Giglio discloses a dental prosthesis that issaid to accommodate the gingival contours surrounding the implantprosthesis by imitating the gingival contours around natural teeth.Since the abutment is rigidly connected to the implant and must alwaysbe axially aligned with the long axis of the implant, the abutment willrarely, if ever, closely engage the entire existing soft tissue socketcreated when a tooth has been extracted; consequently, inadequate softtissue socket adaptation exists. Moreover, seldom is the axis of theimplant exactly aligned with the axis of the soft tissue socket. Also,although the abutment disclosed by this patent has raised ridges aroundits outer perimeter, it is symmetrical, and therefore does not mimic theasymmetric anatomy of a soft tissue socket in the gingiva of a patientfrom whom a tooth has been extracted.

U.S. Pat. No. 5,899,695, Lazzara, et al. discloses an interchangeablehealing abutment and impression coping that is described as an anatomicroot form but fails to describe a means of preserving and/or relatingthe position of the overlying residual soft tissue socket to theunderlying position of the dental implant. Components were described tohave a rigid snap-fit or direct contact with one another allowing ahealing abutment and impression coping to be interchangeable components.Lazzara, et al. also discloses a healing abutment shell in U.S. Pat. No.5,899,697 that is fitted by seating the shell with a positive contactupon the shoulder of the core component of the dental implant therebylimiting the spatial position of the shell to relative position of thedental implant within the alveolar bone. This requirement sets physicallimitations in the vertical, horizontal and transverse positions. Thecomponents are shown to be concentrically designed and related to oneanother and require luting and fixating the components together duringuse. The overall position of the healing abutment is physically dictatedby the position of the dental implant and fixation screw within theroot-from implant. The reference discloses no structure for maintainingor preserving the contours of the gingival soft tissue socket with thepeaks and valleys of the soft tissue socket. There is no description orteaching as it relates to the non-congruous spatial relationship betweenthe underlying root-form implant and residual soft tissue gingivalsocket. There is no means to record the spatial position of the residualsoft tissue socket to the adjacent or opposing teeth of the extractedtooth. Further, and importantly, these teachings only relate to delayedimplant placement, not immediate placement.

U.S. Pat. No. 8,185,224 to Powell, et al. discloses a two piece healingabutment that is to be rigidly connected to a dental implant withpositional and orientation markings for the purpose to determine thelocation of the root-form implant. The healing abutment is connected viascrew that retains a healing abutment in direct contact to theunderlying root from implant. The reference teaches no structure tomaintain or preserve or record the contours of the gingival soft tissuesocket with the peaks and valleys of the soft tissue socket. The“anatomic abutment” is based on root form that does not mimic the shapeof the soft tissue residual socket topography therefore properpositioning and recording is not possible with this design. Theroot-form implant is shown to be centric and/or rigidly positioned tothe healing abutment with markings. There is no description of a meansto relate a non-centric position of the healing abutment related to theroot form implant. There is no description or means to compensate orrecord the independent position of the residual soft tissue socket as itrelates to the independent position of the root-form dental implant. Thehealing abutment is dictated by the position of the root-form implant.

Nowhere in the prior art or in current dental implant wisdom is ananatomically shaped and sized abutment in the form of an asymmetrictubular shell used in conjunction with a dental implant, which is notrigidly or concentrically connected to the implant in advance. As aresult of the invention here disclosed, the shell can be moved andmaneuvered to any orientation with respect to the x-, y- or z-axis in asoft tissue socket to effectively and fully engage the tissue-zone withno space or gap between the outer surface of the shell and the softtissue socket, independent of the position and axial orientation of theimplant in the bony socket. This independent positioning of the abutmentshell and the implant is one of several important advancements of thisinvention over the prior art.

Additionally, the prior art does not describe a hollow shell with peaksand valleys that mimic that which is found in the residual soft tissuegingival socket anatomy. Current designs that claim to be “anatomicabutments” are designed to mimic the root form related to emergenceprofile and shape of a cross-sectional root form but this does not mimicthe shape that is found after an extraction of a tooth as it relates tothe residual soft tissue gingival socket. Prior “anatomic abutments” aredesigned to be used for a delayed implant placement to create anemergence profile based on the root form of a tooth. The presentinvention is related to retaining, preserving and recording the freshextraction soft tissue socket to mimics the gingival contour with thepeaks and valleys that mimic the soft tissue contour of a soft tissuesocket. The prior art does not define the peaks and valleys as describedherein that mimics the residual soft tissue gingival socket. A designwithout the proper peaks and valleys of the transgingival zone asdefined herein lacks the ability to accurately record and maintain thesetissues.

U.S. Pat. No. RE37,227 to Brodbeck also disclosed a some-whatanatomically shaped abutment but again it is axially fixed to an implantso that there is no freedom of movement between the abutment and theimplant but rather they are mechanically coupled to each other whenbeing seated in their respective soft tissue and bone sockets so thatthe position of one is dictated by the position of the other.

An article titled: “Immediate Placement and Provisionalization ofMaxillary Anterior Single Implants: A Surgical and ProsthodonticRationale,” by Kan at al., Pract Periodont Aesthet Dent, 2000; Vol. 12,No. 9, pps 817-824, discloses the building up of an abutment that isfixed to an implant to better match a soft tissue socket by the additionof autopolymerizing acrylic resin around the abutment by sculpting theouter shape of the otherwise fixed abutment to better fill the softtissue socket. This technique also fails to recognize the advantage ofindependently positioning the abutment from the implant. In addition,the tissue-zone collapses immediately upon tooth removal andextrapolation of its contours by the author is required to recreate asclose as possible the soft tissue-zone profile.

Another attempt at accommodating the mismatch between an implantoriented in a bony socket and an abutment positioned in a soft tissuesocket, is suggested in the June 2009 brochure of BIOMET 3i titled“Ideal Solutions For Immediate Aesthetics” that discloses anabutment-implant combination where the abutment axis is at a fixed butnon-aligned angle to the implant axis. Here again there is independentpositioning of the abutment and the implant so freedom of orientation isnot present.

SUMMARY OF THE INVENTION

It is an object of the present invention to solve the problems of theprior art identified above, by providing means for recording the anatomyand the spatial relations of the independent components of the oralcavity after a tooth is removed and an immediate implant is placed intoa fresh extraction site. The independent components are defined asfollows:

1) The shape and spatial position of the clinical crown of the extractedtooth relative to the other dental components discussed.

2) The shape and spatial position of the inter-occlusal contact to theclinical crown of the extracted tooth prior to removal of the toothwhich is relative to the other dental components discussed.

3) The shape and spatial position of an immediate dental implant placedwithin the bone, and its relative position to the other dentalcomponents discussed.

4) The shape and position of the residual soft tissue socket anatomy ofthe gingiva at an extraction site relative to the position of the otherdental components discussed.

Additionally, this is achieved with non-connected components that areindependent from one another.

A hollow shell with orientation and dimensional markings is used torecord and to preserve the soft tissue anatomy. The hollow shellprovides soft tissue preservation as well.

The hollow shell has an interior volume and a shell axis, an outerbio-compatible surface for engaging a soft tissue socket that is left ingingival tissue after a tooth has been extracted from a bone socketunder the gingival tissue, a first perimeter adapted for placementtoward the bone socket and a second perimeter adapted for placementadjacent an outer surface of the gingival tissue around the soft tissuesocket. The first perimeter is smaller than the second perimeter so thatthe shell tapers outwardly from the first to the second perimeters, thesecond perimeter being asymmetrically scalloped with opposite distal andmesial peaks and opposite lingual and facial valleys between the peaks.The shell is sized for closely engaging against the soft tissue socketwithout gaps.

This is only made possible if, in all cases, there is complete freedomof orientation between the shell and the implant-plus-post that allowsindependent positioning between these two components. In one embodimentof the invention markings are provided on the shell and post and theshell and post in their independent positions and with position markingsare scanned and imaged and this image data is used to fabricateabutments, temporary and even permanent crowns. In another embodiment ofthe invention, luting is used to fill in between the shell and post andrather than, or in addition to the position data being recording, theluting fixes or freezes the shell at its own orientation as dictated bythe soft tissue socket, to the post at its own orientation as dictatedby the boney socket.

The invention also includes a dental implant having an implant axis andbeing adapted for placement in the bone socket, a temporary post rigidlyconnected to and coaxial with the dental implant, the temporary postextending in the interior volume of the hollow shell, and eithermarkings on the post and/or a luting compound filling the interiorvolume between the shell and the temporary post and setting solid forfixing the shell to the dental implant with no other connection betweenthe shell and the implant so that the outer surface of the shell engagesagainst the soft tissue socket without gaps and without requiringalignment of the shell axis to the implant axes.

The dental implant connection post has orientation and dimensionalmarkings that provide spatial positioning of the dental implant withinthe bone. The connection post may also serve for retention of materials.

A further and more general object of the invention is to provide adental implant method and arrangement that uses a hollow shell withphysical or visual orientation markings to record the spatialrelationship of the residual soft tissue gingival socket to the spatialrelationship of the underlying dental implant. The shell is imbued withdistinct identification and orientation indications. The markings may beof a design of physical markings, such as indents, detents, internal orexternal tabs or wings and/or visual markings, laser etching, decals,colored markings or other means of recording spatial orientation of thehollow shell and it's relationship to the residual soft tissue gingivalsocket. The markings will also code for the physical shape anddimensions of the hollow shell selected for use. The peaks and valleysof the design mimic the shape and contour of the residual soft tissuesocket allowing the hollow shell to be positioned relative to thenatural occurring peaks and valleys of the residual soft tissue socketopening. A variety of hollow shells are available with differentlengths, widths, shapes and diameters in three dimensions of space. Theimplant spatial relation of the dental implant is recorded from physicalmarkings, detents, indents or visual markings on the temporary postrigidly connected to and coaxial with the dental implant. Recording canbe achieved via a variety of means including but not limited to physicaldental impressions, CAD/CAM, Digital Impressions, X-Ray computertomography or other means (digital or physical) to make record of dentalcasts.

A further object of the invention is to record the three dimensionalanatomy of the soft tissue gingival extraction socket so that it'sspecific soft tissue contour can be replicated without distortion ordimensional changes that occur after tooth removal.

The spatial relationship of soft tissue gingival socket is recordedrelative to the temporary connection post that is rigidly connected toand coaxial with the dental implant, the temporary post extends throughand above (coronal) in the hollow shell. The connection post is imbuedwith distinct identification and orientation indications upon theconnection post. The markings may be of a design of physical markings,such as indents, detents, internal or external tabs or wings and/orvisual markings, laser etching, decals, colored markings or other meansof recording spatial orientation of the connection post and itsrelationship to the residual soft tissue gingival socket. The markingswill also code for the physical shape and dimensions of the connectionpost selected for use. A variety of connection posts are available withdifferent lengths, widths, shapes and diameters in three dimensions ofspace.

The residual soft tissue socket spatial relation relative to theimmediate dental implant can be recorded by a variety of means, notlimited to, physical dental impressions, CAD/CAM, Digital Impressions,X-Ray computer tomography or other means (digital or physical) to makerecord of dental casts. This relationship between the residual softtissue gingival socket relative to the underlying spatial position ofthe dental implant and is recorded using a spatial referencing system inthe X, Y and Z, i.e. horizontal, vertical and transverse planes. Uponrecording the spatial relation of the dental implant to the residualsoft tissue gingival socket a variety of temporary and permanentprosthetic components can be fabricated. Importantly the implantprosthesis components could also be recorded and referenced to theremaining dentition by electronic or physical dental impressions tofabricate a dental prosthesis that is spatially related to the adjacentteeth and gingival tissues. It is also possible to take a pre-operativedigital scan or pre-operative impression so that the replication of theclinical crown of the removed tooth can be electronically or physicallyavailable for fabrication of the prosthesis and its components.Fabrication via laboratory techniques that include direct, indirectdental laboratory fabrication, digital, CAD/CAM, digital milling, etc.can be used. The prosthetic components include a customized abutmentthat can replicate and compensate for the non-concentric positioning ofthe implant relative to the residual soft tissue gingival socket. Theprosthetic transmucosal component of the final dental implant prosthesiscan be fabricated of a variety of materials including but not limited toacrylic or zirconia.

A further object of the invention is to provide a dental implant methodand arrangement that uses a hollow shell with outer bio-compatiblesurface (e.g. of plastic) for engaging a soft tissue socket that is leftin gingival tissue immediately after a tooth has been extracted topromote healing by independently positioning the shell and the implantthat has been fixed in the remaining bony socket, the shell beingtapered outwardly from a first to a second perimeter, the secondperimeter being asymmetrically scalloped with opposite distal and mesialpeaks and opposite lingual and facial valleys between the peaks, thedental implant in the bone or bony socket left after tooth extractionbeing rigidly connected to a temporary post, the temporary postextending in the shell, and either markings provided on the shell andpost for recording image data for abutment or crown fabrication, or aluting compound filling the volume between the shell and the post andsetting solid for fixing the shell in its position and orientation asdictated by the soft tissue socket, to the post and dental implant intheir position and orientation as dictated by the boney socket, with noother connection between the shell and the implant so that the outersurface of the shell engages against the soft tissue socket without gapsand without requiring alignment of the shell and implant axes.

Other objects of the invention are to use the shell as a biological sealfor both the soft tissue socket and for the bony socket, to precludecontaminants from the soft tissue and from the bony sockets.

Another object of the invention is to use the shell as a foundation fora temporary prosthetic tooth for immediately cosmetically replacing anextracted tooth.

Other objects of the invention will become apparent after consideringthe following more detailed disclosure of the invention.

The various features of novelty which characterize the invention arepointed out with particularity in the claims annexed to and forming apart of this disclosure. For a better understanding of the invention,its operating advantages and specific objects attained by its uses,reference is made to the accompanying drawings and descriptive matter inwhich preferred embodiments of the invention are illustrated.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings:

FIG. 1 is an exploded view of important part of the arrangement of theinvention;

FIG. 2 is a perspective view of a different embodiment of the shell ofthe invention for use in replacing a different tooth type;

FIG. 3 is a perspective view of a still further embodiment of the shellof the invention for use in replacing a different tooth type;

FIG. 4 is a perspective view of an embodiment of the shell of theinvention that illustrated the asymmetry of the outer perimeter of theshell;

FIG. 5 is a perspective view of the shell of the invention shown also inFIG. 1 for comparison with the shell shapes of FIGS. 2 to 4;

FIG. 6 is a sectional view of the arrangement of the invention after aluting compound has been applied;

FIG. 7 is a composite, side-by-side, rear (lingual) and front (facial)perspective view of an immediate tooth-form temporary of the invention;

FIG. 8 is a composite view of parts of the arrangement of the inventionin a sequence showing an assembly of the parts of the arrangement;

FIG. 9 is a composite sectional view of the invention with a hollowshell and a connection post;

FIG. 10 is a composite sectional view of the invention with the hollowshell with three distinct visual markings on the occusal edge of thecoronal surface and a connection post also with distinct visual markets;

FIG. 11 is a view similar to FIG. 10 showing the dental implant at adifferent angle to illustrate the real-world variations in position andangle the exist in actual tooth roots;

FIGS. 12 to 18 are side views of embodiments of shells of the inventionwith different types of markings;

FIGS. 19 to 26 are side views of connecting posts of the invention withdifferent types of markings;

FIGS. 27 to 31 are sectional views of connecting posts of the inventionwith different shapes;

FIG. 32 is a perspective view of a finger-driven or mechanical driverfor driving the connecting post of the invention;

FIGS. 33 to 35 are perspective views of various post drivers providedfor driving a post of a complementary cross sectional shape;

FIG. 36 is a perspective view of a shell 10 with horizontal laser etchedlines for use as a measuring gauge to determine the proper depth orheight of a transgingival residual soft tissue socket 100 that is leftafter a tooth extraction so that a properly sized shell can be selected;

FIG. 37 is a composite illustration of a first scanning step of anembodiment of the invention;

FIG. 38 is a composite illustration of a second scanning step of anembodiment of the invention;

FIG. 39 is an illustration of a third extraction step of an embodimentof the invention;

FIG. 40 is an illustration of a fourth immediate implant placement stepof an embodiment of the invention;

FIG. 41 is an illustration of a fifth hollow shell placement step of anembodiment of the invention;

FIG. 42 is an illustration of a sixth connection post placement step ofan embodiment of the invention;

FIG. 43 is an illustration of a seventh scanning step of an embodimentof the invention;

FIG. 44 is an illustration of an eighth data processing step of anembodiment of the invention; and

FIG. 45 is a side view of a connection post of the invention with abreakaway feature.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Apparatus and Arrangement of the Invention:

Referring now to the drawings, in which like reference numerals are usedto refer to the same or similar elements, FIG. 1 illustrates a softtissue preservation, dental implant arrangement that comprises a hollowshell 10 with an interior volume and a shell axis 12. The shell isadvantageously made of zirconium dioxide (ZrO₂) ceramic material that isknown to be bio-compatible. The hollow shell 10 thus has an outerbio-compatible surface for engaging a soft tissue socket that is left ingingival tissue after a tooth has been extracted from a bone or bonysocket under the gingival tissue. Shell 10 has a first lower perimeter16 adapted for placement toward the bone socket of a lower mandibular,tooth. The first or inner perimeter 16 may be an upper perimeter if theshell is to be used for replacing of an extracted upper or maxillarytooth so that terms like “upper” and “lower” as used here are onlyrelative terms and do not convey an absolute position or limitation ofthe invention.

Shell 10 also has a second or outer perimeter 18 adapted for placementadjacent an outer surface of the gingival tissue, around the soft tissuesocket. The first perimeter 16 is smaller than the second perimeter 18so that the shell 10 tapers outwardly from the first to the secondperimeters to anatomically mimic the shape of the soft tissue socketthat remains immediately after a tooth has been extracted, and beforethe soft tissue socket starts to shrink or shift from the natural size,shape and position it had around the patient's natural tooth beforeextraction.

To further anatomically mimic the shape of the soft tissue socket, thesecond perimeter 18 is also asymmetrically scalloped with oppositedistal and mesial peaks 20 and 22, and opposite lingual and facialvalleys 24 and 26, between the peaks. The shapes, sizes, locations andheights of the peaks and valleys are selected to mimic known toothtypes, e.g. maxillary or mandibular, central or lateral incisors,canines, premolars and molars, and the shell is also sized for closelyengaging against the soft tissue socket without gaps of many toothshapes, types and sizes. This sizing and shaping is achieved byproviding the practitioner with a set or selection of different shellshapes, sizes and types, so that a shell 10 that is close in fit to thesoft tissue socket is available, so that the shell engages the softtissue socket without gaps and thus forms a biological or biologic-sealto preclude contaminants from the soft tissue socket and from the bonysocket in the bone under the soft tissue.

As will be explained more fully in the following, the present inventionallows this placement of the properly sized and shaped shell 10, in thesoft tissue socket, with complete freedom of motion in the x-, y- andz-directions and, just as importantly, with complete freedom of rotationabout all three axes. This is done by independently positioning theabutment that is formed by this shell from the solid implant and itsconnected post that must be rigidly fixed in the bony socket at its ownoptimum angle and depth.

A dental implant 30 having an implant axis 32 is provided and is adaptedfor placement in the bone socket immediate after tooth extraction,clearing and dressing of the bony socket in a conventional manner, forexample, by removing debris and drilling an immediate implant receivingbore in the bone or bony socket using known techniques.

A temporary post 40 is then rigidly connected to and is coaxial with thedental implant 30, for example, by using a screw 50 that is insertedinto a central bore in the post 40 and screwed into a treaded bore inthe top center of the implant 30. A head 52 engages an annular step inthe post 40 in a known manner, to fix the post 40 to the implant 30. Thetemporary post 40 extends in the interior volume of the hollow shell 10but is not yet connected to the shell, and need not even touch theshell, so that despite the fixing of the post to the implant, the shellcan be engages to the soft tissue socket without directional orrotational limitation.

An initially fluid luting compound shown at 60 in FIGS. 6 and 8, isfilled into the interior volume between the shell 10 and the temporarypost 40 and is allowed to set solid. Only then is the shell 10 fixed tothe dental post 40 and implant 30, with no other previous connectionbetween the shell and the implant so that the outer surface of the shellengages against the soft tissue socket 100 without gaps and withoutrequiring any alignment between the shell axis 12 and the implant axes32. This also seals the bony socket 102 in the jaw bone 106, which, inthe case of FIG. 6, is the maxilla that is shown to have other teeth 104on opposite sides of the extracted tooth socket 102. The inner surfaceof shell 10 is adapted to adhere well to the luting compound 60 for thisembodiment of the invention. This is done by making the shell, andtherefore its inner surface, of a material that adheres well to theluting compound, e.g. zirconia, or by treating the inner surface, e.g.by roughening its texture, or by applying a special coating to the innersurface that adheres well to the shell material and to the lutingcompound when the compound hardens.

As illustrated in FIGS. 1 and 5, the lingual valley 24 is lower than thefacial valley 26 for mimicking maxillary and mandibular incisors forexample. For mimicking maxillary and mandibular canines, the valleys 24and 26 can be of substantially equal in height as illustrated in FIG. 2.For premolars and molars, the opposite of incisors is true so that asshown in FIG. 3 the lingual valley 26 is higher than the facial valley24 and mesial and distal peeks 20 and 22 are not as highly scalloped asin incisors. Also for some or perhaps most tooth types, the distal andmesial peaks 20 and 22, as shown in FIG. 4, are not in a common plane 23with the plane 25 extending through the shell axis 12. The asymmetry isalso selected to more closely mimic the true shape and size of a softtissue socket before it starts to deteriorate. These rules are notabsolute since there can always be exceptions and variations to therules because dental anatomy varies and may sometimes reside outside thenorms. The set of shell in various sizes, types and shapes provided tothe practitioner can accommodate to these variations by allowing thepractitioner to select a shell for a different tooth replacement typeor, in extreme cases, may arrange for a custom made shell for aparticular patient.

Other parts that may be included as part of the arrangement of theinvention to be explained later in this disclosure, include a tooth formtemporary 70 in FIG. 7, that can be fixed to the outer perimeter 18 ofthe shell 10, after it has been luted to the post 40, so that thepatient has a temporary tooth replacement before leaving the dentaloffice. The arrangement may also includes a cylindrical nylon plug 80 inFIG. 8, that is used to temporary plug the interior volume of the post40 above the securing screw 50, before the luting step, so that accessto the head 52 of the screw 50 can be reestablished when a permanenttooth replacement is to be attached to the implant, or at other pointsin the process of the invention, by extracting the plug.

Methods and Procedures of the Invention:

With reference to FIGS. 6 and 8, the method of the invention permitsimmediate implant soft tissue abutment temporary placement at the timeof tooth extraction to re-establish an effective biologic-seal of thesoft tissues to the surface of the abutment or shell more effectively toits anatomic shape.

The immediate implant soft tissue abutment temporary may be:

1. An immediate soft tissue implant abutment temporary extending fromthe crest of bone 110 to the height of the remaining soft tissues 108.The immediate soft tissue abutment temporary will re-establish abiologic-seal preserving the gingival soft tissues after the removal ofa tooth and the immediate placement of an implant. It also enablescontainment of bone regenerative materials and primary coverage of thebarrier membrane if used after tooth removal; and/or

2. An immediate tooth-form implant temporarily re-establishes abiologic-seal preserving the gingival soft tissues after the removal ofa tooth and the immediate placement of an implant. It also enablescontainment of bone regenerative materials and primary coverage of thebarrier membrane if used after tooth removal.

The immediate implant soft tissue abutment temporary is a temporarycomponent that connects to the implant-platform (superior surface of theimplant platform) at the bone crest 110 and extends to the level of thefree-gingival margin of the soft tissue 108. It provides the necessaryshape and adaptation to re-establish a biologic-seal between the softtissues and the surface of the temporary.

An immediate tooth-form temporary (provisional) 70 of the invention isshown in FIG. 7 and is a temporary component who's subgingivaltransmucosal section 72 is shaped similar to a root surface andrepresents the immediate transmucosal temporary (Provisional) describedabove and who's supragingival component is shaped like a tooth. It iscomposed of a shell 70 that extends from the implant-platform of theinvention that includes the luted shell 10, and extends from the outerperimeter 18 of shell 10 beyond the level of the free-gingival margin tothe incisal edge or occlusal surface of the dental tooth it isreplacing. Tooth form 70 comes in a variety of different verticalheights, elliptical shapes and different dimensions to temporallyreplace the various types of teeth that might be extracted. It will beprovided to dentist as a kit in which a variety of different sizes,shapes and types are available to replace different teeth that areextracted.

Critical to the design is creating an effective biological socket-sealbetween the surface of the abutment-temporary (provisional) toadequately support and seal the residual soft tissue socket at the timeof placement. The subgingival shape of the abutment-temporary(provisional) promotes biological socket seal by providing either anover-contoured or under-contoured emergence profile to compensate forthe position of the dental implant.

Additionally, the abutment-temporary design provides a single uniformmaterial within the soft tissue zone of the residual soft tissue socketthat prevents a micro- and macroscopic gap between dissimilar materialsin the soft tissue gingival zone.

The abutment-temporary subgingival emergence profile provides anover-contoured or under-contoured shape that is anatomical to compensatefor the three dimensional position of the underlying endosseous implantspatial position.

The abutment-temporary dental implant prosthesis is designed to be aninterim prosthesis that is fabricated chair-side and is customized toprovide individual unique tooth replacements. The temporary shell isdesigned from a series of elliptical and asymmetric shapes that have aneccentric opening for access to accept a cylindrical component that isattached via a screw mounting to the dental implant.

A self-curing material is used to affix the shell to a screw-retainedtemporary post 40 during the chairside fabrication of theabutment-temporary. The abutment-temporary (provisional) is modifiedchairside to generate a unique final shape and provide an adequate sealbetween the abutment-temporary (provisional) and the soft tissue socket.Preformed non-concentric elliptical shells provide a matrix to fabricatethe abutment-temporary dental implant restoration.

The immediate abutment-temporary, that can also be thought of as animmediate provisional abutment, has one interface region between thedental implant and the overlying abutment-temporary. The interface is atthe level of the implant buccal plate and contained at the level of bonecrest. This eliminates the micro- and macroscopic gap from beingpositioned within the soft tissue zone of the soft tissue residualsocket for immediate implant placement into a fresh extraction site.

Additional Embodiments

With reference now to FIG. 9, hollow shell 10 may have markings, e.g.three distinct visual markings 10 b (i.e. holes) on or near the occusaledge or outer, second perimeter 18 of the coronal surface of the peaksand valleys of the shell are seen in a side sectional view through thebone 110 and gingiva 108 of a patient. A connection post 40 with otherdistinct visual markets 40 b is also provided and has been screwed intothe dental implant 30. Markings 10 b and 40 b for both component 10 and40 provide alignment information so that the physical dimensions of thecomponents are recorded as well. The hollow shell 10 must not makephysical contact with the connection post 40 and/or the dental implant30. Scanning of the image of the marked shell 10 and post 40 using anynumber of known scanning techniques as will be explained later, recordsthe exact position and relationships of the shell and post with respectto the implant 30. This information can be used to create a correctlysized and oriented healing abutment or temporary crown or even apermanent crown that will properly connect to the implant and that willclosely engage the soft tissue socket.

FIG. 10 shows a front view of the area of FIG. 9 to better illustratethe markings and orientation of the shell 10, post 40 and implant 30,showing the three distinct visual markings on the occusal edge of thecoronal surface. The connection post 40 with similar distinct visualmarkets is again noted. Markings for both components are embedded withinformation so that the physical dimensions of the components arerecorded as well. It is noted that a gap G is present between theimplant shoulder 30 a and the shell 10. Axial orientation of the twocomponents is dissimilar so that each is oriented as needed, i.e. theimplant 30 the tooth root and the shell 10 to the soft tissue socket.Recording the relative position of the hollow shell and its relationshipto the connection post 40 can be established by scanning. Thisrelationship between the residual soft tissue gingival socket 102relative to the underlying spatial position of the dental implant isrecorded using this spatial referencing system in the X, Y and Z, i.e.horizontal, vertical and transverse planes.

The shell is hollow with distinct markings and is of generally tubulardesign to accommodate to the position of an immediate root-form implant30 positioned at multiple locations within the residual socket 102. Thehollow shell does not make contact with the immediate root-form implantor the connection post that is rigidly fixed to the root-form implant.

The method and apparatus in the preferred embodiment provide aconnection post rigidly fixed to the implant that has distinct markings.The connection post 40 is connected to the root-form implant 30 byscrew, frictional interference or other means of securing the connectionpost to the root-from implant. The connection has distinctidentification and orientation indications as noted. The markings may beof a design of physical markings, such as indents, detents, internal orexternal tabs or wings and/or visual markings, laser etching, decals,colored markings or other means of recording spatial orientation of theconnection post and its relationship to the root-form implant. Themarkings will also code for the physical shape and dimensions of theconnection post selected for use. A variety of connection posts are madeavailable with different lengths, widths, shapes and diameters in threedimensions of space.

The method and device provides means to physically or digitally recordthe spatial relationship of the two non-concentric components. It ispossible that the components do not make physical contact with oneanother. The orientation markings on both the hollow shell andconnection post enable the relative position of the two components to berecorded in spite of small or large discrepancies in the x, y, zdimensions. Once the spatial relationship is digitally or physicallyrecorded Analogue components (physical or digital) can be used tofabricate a physical or electronic model. Fabrication of a variety ofprosthetic components can be initiated. The prosthetic components can bea temporary abutment, temporary abutment with crown, two piece crown andabutment and/or monolithic temporary restoration or final restoration.Importantly the prosthesis components would be also be recorded andreferenced to the remaining dentition by electronic or physical dentalimpressions so that the fabrication of the prosthesis and it componentsare spatially related to the remaining teeth and gingival tissues. It isalso possible to take a pre-scan or pre-op impression so that thereplication of the clinical crown of the tooth removed can beelectronically or physically available for the fabrication of theprosthesis and its components.

The method and device promotes cellular soft tissue adherence to thesurface of the immediate implant soft tissue temporary (Provisional)abutment.

The method and device preserves the soft tissue architecture of thegingival surrounding the immediate implant soft tissue temporary(Provisional) abutment.

The method and device enables bone regenerative materials to be retainedin any gap left around the top of the implant 30, and protected duringinitial healing but the shell, in effect, sealing this area from theouter end of the soft and bony sockets.

The immediate implant soft tissue abutment temporary, i.e. shell 10,method has the following features or steps.

The method and device in the preferred embodiment uses a surgicallysterile surface for shell 10 with distinct identification andorientation indications upon the hollow shell. The markings may be of adesign of physical markings, such as indents, detents, internal orexternal tabs or wings and/or visual markings, laser etching, decals,colored markings or other means of recording spatial orientation of thehollow shell and its relationship to the residual soft tissue gingivalsocket. The markings will also code for the physical shape anddimensions of the hollow shell selected for use. A variety of hollowshells are made available with different lengths, widths, shapes anddiameters in three dimensions of space. The hollow shell creates anintimate to fit to the socket anatomic shape at the time of toothextraction. A variety of pre-fabricated hollow shells are provided withdifferent sizes and shapes that confirm to the residual soft tissuegingival socket. The hollow shell surface is of a bi-layer micro-textureto promote immediate soft tissue repair and adaptation promotingre-attachment or repair to the biologic surface. It is anticipated thatthe surface may have a regular micro-geometric pattern that is uniform.It is also anticipated that the surface texture may be modifiedchairside using a rotary instrument such as a uniquely designed dentalbur, that results in a ordered microgeometric repetitive surface patternin the form of alternating ridges and grooves, each having a unfixedwidth in a alternating range of about 2.0 to about 25 microns(micrometers) and a nonfixed or altering depth in a range of about 10microns to about 50 microns, in which the microgemoetric repetitivepatterns define a guide soft tissue preservation and re-attachment thesoft tissue fibers to the surface of the immediate implant soft tissuetemporary abutment.

In FIG. 12, the shell 10 has markings in the forms of three inwardlyconvex bumps 10 a spaced around the inner surface of the shell, near itssecond or outer perimeter 18 so are to be easily visible to apractitioner. In the embodiment of FIG. 13, the markings arecircumferentially spaced holes 10 b through the shell, and in FIG. 14the markings are circumferentially spaced wings 10 c on the innersurface of the shell. In the embodiment of FIG. 15, the markings arecircumferentially spaced shapes of different types, e.g. triangle,square and rectangle. FIG. 16 has outwardly projecting markings ofdifferent shapes and in FIG. 17 and markings are in the form of cutoutsor noticed of different shapes. In FIG. 18 the marking is in the form ofone or more information containing bar code.

FIGS. 19, 20 and 21 illustrate connecting posts 40 of the invention withlower threaded ends 40 a and circumferentially and/or axially spacedprojections 40 b in FIG. 19, or holes 40 c in FIG. 20, or axially spacedrings 40 d in FIG. 21. FIG. 22 has rings that are either transverse tothe post axis at 40 e, or at an acute angle to the axis at 40 f or havemore than one ring, e.g. crossing rings 40 g. Post 40 in FIG. 22 alsohave a larger diameter stop 40 h to positively setting the axialposition of the post 40 on the implant 30. This large diameter portionmay be just near the threaded portion at the bottom of the post or itmay extend part or al the way up the coronal (exposed) portion of thepost. FIGS. 23 to 26 illustrate various axially spaced markings typesthat can be used on the outer end of the post 40 for visual inspectionand use with the markings in the shell 10.

To facilitate attaching the post 40 to the implant 30, the post may havea circular cross section as in FIG. 27 that may included an endprojections that is non-round like a triangle of FIG. 28, or a hexagonof FIG. 28 or an octagon of FIG. 30 or a rectangle of FIG. 31 making upthe entire post or an end projection of the post, that is engaged by afinger or mechanical tool shown in FIG. 32 that had an engagement endwith shapes as shown in FIGS. 33 to 35 for screwing the post 40 into theimplant 30. FIG. 36 illustrates a sizing shell 10S that has marks in theform of circumferential bands 10 d that are axially spaced along theupper outer surface of the shell. In use the practitioner places thesizing shell 10S into the patients soft tissue socket either before orafter the connecting post 40 is in place, and observes there the uppermargin of the soft tissue socket reaches with respect to the markings.This will give the practitioner a guide to select a shell 10 of properaxial height for the size of the patient's soft tissue socket.

Description of Methods:

It is understood in the description of the method and device that theplacement of an immediate soft tissue preservation implant abutment hasthe intended use for the extraction and replacement of a single tooth ormultiple teeth. The method will be described for a single tooth, but itis understood that the deception of the method and device is not limitedto a singular tooth but implies a description for multiple teeth asadditional embodiments of the invention. FIGS. 6 and 8, illustrate onepreferred embodiment of the method of the invention as was detailedabove and that results in an immediate temporary abutment or crown,while FIGS. 37 to 45 illustrate another preferred embodiment of themethod of the invention that is used to gather image information aboutthe exact angle and depth of the implant as well as the size andorientation of the soft tissue socket. This critical and accurateinformation can then be used to create a perfectly sized and anglesabutment, temporary crown or even a permanent crown that anatomicallyfits the soft tissue socket while being properly oriented and securelyconnected to the implant, unlike the prior art that universally forcesthe soft tissue socket to conform to the idealized abutment that must beaxially aligned with the implant while ignoring the actual anatomy ofthe socket.

At Step 1 in FIG. 37, the diagnosis that a tooth requires extraction isdetermined by the dental clinician. The diagnosis is preformed usingconventional means including clinical examination, radiographicanalysis, detailed past dental history and the review of signs andsymptoms. The patient is informed of the treatment alternatives and anappropriate informed consent to treatment is provided to the clinician.During the diagnostic phase a suitable sized hollow shell 10 for thetransgingival zone of the residual soft tissue gingival socket can beselected based on dimensional measurements taken from the radiographicrecords and analysis. A CBCT scan 200 or other means of radiographicstudies are suitable for selection of the hollow-shell. It is alsopossible to select the proper size of the hollow-shell using the sizinghollow-shell 10S with its horizontal laser etched lines 10 h todetermine the proper depth or height of the transgingival residual softtissue socket as shown in FIG. 36, but this can only be done afterextraction.

Prior to the extraction of the tooth an electronic recording withscanning technology or photographic means is taken to allow futurecomparison of the pre-treatment condition that was present versus thepost-operative outcome after treatment is completed. The image may havea reference measurement tool or instrument so that detailed analysis ofthe soft tissue changes can be analyzed.

A dental impression is taken either using conventional impressionmaterials such as alginate, polyether, vinyl polysiloxane, or othermaterials to establish an accurate representation of the teeth andsurrounding gingival tissues. It is understood that the describedembodiment may also be performed using a digital impression such aslaser scanning, photographic imaging, mechanical sensing, cone beamcomputer tomography or digital oral impression (CAD/CAM DigitalImpressions) using a hand-held oral scanning device 200 of known design.

A digital scanning or impression is taken of the maxillary MAX andmandibular MAN arches, including teeth and gingival tissues, inparticular including the tooth T to be extracted and the adjacent teethof the tooth to be extracted.

The clinical crown (i.e. the portion of a tooth exposed beyond thegingiva) of the tooth to be extracted is scanned or recorded in FIG. 38,either with electronic means or a physical impression to record theshape, size and topography relative to the adjacent teeth andsurrounding gingival tissues. This is done with the patient's jaw closedso that this occlusion scanned information can be spatially referencedto the position of the residual soft tissue gingival socket once usingthe hollow shell with orientation markings once the tooth is extractedand a bite record is also made. This dimensional information is used inthe fabrication of the dental implant prosthesis components.

A digital scanning or bite registration of the opposing teeth is thusrecorded in Step 2 of FIG. 38 with either an electronic scanningtechnique or a physical bite registration material. The occlusal surfacecontact to the clinical crown of the anticipated extracted tooth isrecorded to record the spatial relationship of the teeth to the positionof the residual soft tissue gingival socket. This dimensionalinformation is used in the fabrication of the dental implant prosthesiscomponents. The opposing arch contact to the tooth to be extracted isrecorded to enable the opposing contacts of occlusion to be establishedin the laboratory model to be used for fabrication of the components ofan implant restoration.

In Step 3 of FIG. 39, the area of the mouth in which the tooth T is tobe extracted is anesthetized with a dental local anesthetic solution. Alocal anesthetic solution can be delivered to the area either as localinfiltration dental injection or as a regional nerve block to the area.The patient is given adequate time (typically 5 minutes) for the dentallocal anesthetic to anesthetize the region of the mouth that is beingtreated.

Extreme care is used to preserve the entire tissue-zone and minimizetrauma to the supporting gingival tissues 106 during each phase oftreatment. It is critical to preserve the soft tissue architecture orsocket 100 of the immediate and surrounding gingival in order tore-establish the biologic-seal after the tooth is removed and theimmediate soft tissue implant abutment, i.e. shell 10, is placed.Therefore a flapless surgical technique is used.

The next Step 3 to performing the method of the invention is tocarefully incise the entire supra-crestal attachment of the tooth to beextracted, 360 degrees around the tooth, i.e. around soft tissue socket100. It is important to surgically disconnect the soft tissue attachmentfibers. This can be accomplished using a surgical blade, piezo-surgicalinstrument, micro-rotary dental handpiece or dental laser soft tissuecutting instrument. The method requires careful dissection of thesupra-crestal attachment which includes the sucular epithelium,junctional epithelium, and the connective tissue inserting fibers whichare found between the connective tissue and the surface of the rootabove the crest of bone. Once the supra-crestal fibers are released thesuperior periodontal ligament fibers (attachment fibers found betweenthe alveolar bone socket and root surface) can next be incised.

The superior periodontal fibers attach the surface of the tooth(cementum) to the inner bony socket must also be severed using minimaldisruption to the surrounding soft tissue and bony architecture. Thiscan be accomplished by using micro-surgical instruments, periotomes, arotary diamond pointed diamond, piezeo-surgical instrument, laser. It isimportant that the instrument diameter is between approximately 20microns to 50 microns (or ⅛ to ¼ millimeter in diameter) as this is thedimension of the width of the periodontal ligament space. The surgicalinstrument is placed into the entrance of the periodontal ligamentbetween the tooth 104 and inner socket wall 100. The periodontalattachment fibers are served around the tooth to a depth of 1 to 4millimeters, depending on ease of entry into the periodontal ligamentspace.

The extraction of the tooth is first initiated using a rotationalmovement in order to severe the remaining subcrestal periodontal fibersattaching the tooth to the inner socket wall. This can be performed witheither using a reduced diameter elevator, periotome or extractionforceps. Once a rotational movement is achieved a vertical force can beapplied to the tooth to advance the root out of the bony socket 102.

When the extraction is performed using this method minimal disruptioncan occur to the surrounding soft tissues 106 of the gingival. Theinterdental papillae are not surgically altered from the pre-treatmentcondition. Incisors are not made which compromise the blood supply tothe region of the bone or surrounding soft tissue gingival. Thearchitecture of the soft tissue has not be altered other than thesevering of the attachment fibers between the root surface and insertingfibers.

As part of Step 3, removal of any inflammatory granulation tissue withinthe bony socket 102 may be necessary. This is performed using a smallsized circular curette. Inspection is performed to ensure the integrityof the remaining inner socket walls 100. A radiograph may be taken todetermine the remaining configuration of the tooth socket. This step isreferred to here as preparing the bony or bone socket.

After the boney socket 102 is prepared following known dentalprocedures, immediate insertion of dental implant 30 is performed inStep 4 as illustrated in FIG. 40. A dental implant 30 is immediatelyplaced within the residual extraction socket 102. The term “immediately”as used here means that the implant is placed shortly after the bonysocket has been fully prepared to receive the implant, 10 to 30 minutesfor example, but importantly during the same patient's visit.

The vertical position of the implant is established. The implant 30 canbe placed at the level of the remaining crest of bone 110. Since theremaining crest of bone has different heights the implant may beslightly supra-crestal as one region and slightly subcrestal at anotherregion of the socket, this is to be expected.

The horizontal position of the implant is established. The implant 30 isto be ideally placed with the implant axis 32, axial position allowingfor a screw-retained temporary. The center axis of the implant 32 musttherefore be placed in the position of the root socket 102 to engaging amaximum volume of remaining bone. The implant is positioned toward thepalatal (lingual) aspect of the residual extraction socket 102 whenpossible. It is noted that the implant 30 will not be placed in thecenter of the socket 102 as this would result in the retention screw ofthe immediate-temporary to exit through the incisal edge of the toothand will result in an esthetic compromise of the restoration.Positioning the implant biased toward the palatal (lingual) position ofthe extraction socket is critical so that a screw-retained immediatetemporary restoration can be used. This advantageous placement of theimplant is made possible by the fact that the abutment or shell 10 ofthe invention is independently positioned relative to the implant andneed not be affixed with respect to the axis or position of the implantas has always been the case in the past. The preferred embodiment of theinvention is an immediate screw-retained temporary to eliminate the needfor cementation of the temporary. Retention of the immediate temporaryrelies upon mechanical retention of the screw. It is anticipated thatthe immediate temporary could be designed in with a temporary design inwhich it is cemented to the substructure directly and places thelocation of the gap below the soft tissue zone.

It is also noted that the soft tissue axis 12 of soft tissue socket 100,will rarely be coaxial with the implant axis 32 as shown in FIGS. 10, 11and 40 and it is the ability of the present invention to accommodatethis anatomical reality without forcing a deformation upon the softtissue socket 100, by independently positioning the shell 10 withrespect to the implant 30, that most drastically distinguishes thepresent invention from the prior art.

The immediate implant 30 must mechanically engage and lock into aportion of the remaining bone. This may be achieved at the apical end ofthe implant. It may also be achieved on a lateral portion of the surfaceof the implant.

It is understood that the implant diameter will be smaller then thegreatest diameter of the root of the tooth that was removed. Thereforethe dissimilar diameters between the immediate implant and the residualbony tooth socket must result in a lateral “gap” or space between theresidual bony socket 102 and the surface of the implant 30 as shown, forexample in FIG. 6. Filling the entire tooth socket 102 is not desirable,as this method relies upon a residual gap between the facial surface ofthe immediate implant and the remaining buccal plate of bone. This gapwill then allow for the placement of a bone regenerative material to beplaced between the implant surface and the inner tooth socket buccalplate. The gap allows for future bone regeneration via the in growth ofthe blood supply and new osteoblasts. It is important not to use aimplant diameter that would make direct contact to the labial plate ofbone as this would compromise the blood supply that is needed topreserve the labial (buccal) plate of bone as the implant surfaceprovide no ability for angiogenesis. This is critical point toappreciate and understand. The preservation of the overlying gingivaland surrounding soft tissues is preserved by several critical factors:(1) a minimally invasive surgical approach; (2) preservation soft tissuearchitecture; and (3) preservation and promotion to re-establish theblood supply to the surrounding tissues.

FIG. 41 shows how a marked version of shell 10 is used during Step 5, asa first orientation component. Hollow shell 10 that has been selected tobest fit the soft tissue socket 100 which at this early time afterextraction has not collapsed or become overly deformed is now placed insocket 100 during Step 5. Placement of the hollow shell with orientationand dimensional information markings 10 a or 10 b or 10 c (see FIGS.12-18), is fitted into the residual soft tissue gingival socket 100 sothat a contact is made between the entire perimeter and the internalsurface of the soft tissue socket as previously described. The hollowshell with distinct visual or physical markings provides orientation andshape and size of the socket may be performed.

Step 6 illustrated in FIG. 42 can actually occur before Step 5 but itmay be more convenient to execute the shell placement Step 5 before thesecond orientation component in the form of the temporary, connectingpost 40 is placed. The connection post 40 is affixed into the root-formimplant 30 by having its lower threaded end 40 a screwed into thethreaded hole in implant 30 as shown in FIG. 42. The first component(shell 10) and second component (post 40) are separate and do not makephysical contact so that the second component does not influence theposition of the first component in any way.

This independent positioning is further insured by the requirement thatthe minimum inside diameter of shell 10 always be greater than themaximum outside diameter of post 40. This relation is also true for theembodiment of FIGS. 1-8, that includes a separate securing screw 50 tosecure the normally larger diameter post 40 that is designed for usewith luting compound.

The spatial relation of the two independent and marked components 10 and40 in FIG. 42 is recorded as noted above as part of Step 7 illustratedin FIG. 43. That is, the position of these two components is recorded bymeans previously discussed using scanning 200 or physical dentalimpressions to fabricate an electronic model or a laboratory dentalmodel. The model (electronic or physical) can then related and indexedto the pre-treatment models previously taken. The models provide the x,y, z spatial coordinates of the residual soft tissue gingival socketrelated to the other dental components described including the clinicalcrown and the contacts of the adjacent and opposing teeth of theextracted tooth.

The connection post 40 is selected for the proper vertical height sothat the connection post extends beyond the coronal surface of thehollow shell 10. The connection post can be screwed retained ormechanically retained by a frictional interference into the internalthreaded portion of the root-form implant 30. A vertical stop 40 h onthe connection post 40 (see FIG. 22) will define a vertical relationshipof the post and root form implant 30 relative to the hollow shell 10 andresidual soft tissue gingival socket 100. Distinct markings on theconnection post coronal section provide the orientation, vertical,horizontal and transverse of the position and dimensional specificationsof the connection post. The connection post directly provides thespatial position of the root-form implant contained within the bonerelative to the residual soft tissue gingival socket.

FIG. 44 illustrates the sequence of electronic data recoding via imagescanning at step 210 or dental impressions at step 212, with the data orimpression used for physical or electronic dental modeling in step 214,followed by fabrication in step 216.

In all embodiments of the invention the connection post 40 and thehollow shell 10 are independent from one another so that neithercomponent influences the position of the other. Non-centric positioningof the implant relative to the hollow shell can be recorded by use ofindividual components. Acute angles between the position of the residualsoft tissue gingival socket and the root-form implant can be obtainedfrom the two separate components placed independently.

As shown in FIG. 45, the connection post coronal section 40 i may bedesigned with undercuts 40 j or a roughened surface 40 k to allowmaterials to be attached to the surface at a later time. A breakaway cutor weakened area 40 m may also be provided to allow for a definedbreaking location incase excess lateral force or torque is applied tothe post 40, so that an accessible portion of post 40 remained above theimplant 30, so that the remaining post portion can be removed form theimplant.

The connection post 40 may be used as a means to retain the hollow shell10 during the fabrication of a temporary or a screw-retained temporarypost may be inserted into the root-implant, e.g. to form part of thetemporary abutment.

Fabricating the Temporary Abutment:

Returning to the embodiment of FIGS. 1-8, the screw-retained temporarypost 40 is connected by screw 50 to the dental implant 30 that in turnis held within the boney socket 102.

The immediate soft tissue abutment shell 10 is selected for the propervertical and horizontal dimensions either by eye or using the sizingshell 10S. The immediate soft tissue preservation abutment shell 10, asnoted above, is supplied in different dimensions depending upon thetooth to be replaced. It will have series of defined dimensionsexternally. These dimensions will include a series of differenttissue-zone heights ranging from 2 mm to 5 mm. It will be provided inseveral root form configurations and be provided in more then onehorizontal widths. An example of the horizontal dimensions could be, butnot limited to:

Maxillary Right Central Incisor: Height 2 mm, Height 3 mm, thru 5 mm.Diameter, Small, Medium and Large. An irregular superior surface isprovided to conform to the soft tissue gingival architecture. Theinterproximal points will be longer in dimension then the labial andlingual surfaces. The inner shell allows for the eccentric position ofthe shell over the center axis of the implant held within the bone.

Maxillary Right Lateral Central Incisor: Height 2 mm, Height 3 mm, thru5 mm. Diameter, Small, Medium and Large. An irregular superior surfaceis provided to conform to the soft tissue gingival architecture. Theinterproximal points will be longer in dimensions then the labial andlingual surfaces. The inner shell allows for the eccentric position ofthe shell over the center axis of the implant held within the bone.

Maxillary Right Canine: Height 2 mm, Height 3 mm, thru 5 mm. Diameter,Small, Medium and Large. An irregular superior surface is provided toconform to the soft tissue gingival architecture. The interproximalpoints will be longer in dimensions then the labial and lingualsurfaces. The inner shell allows for the eccentric position of the shellover the center axis of the implant held within the bone.

Maxillary Left Central Incisor: Height 2 mm, Height 3 mm, thru 5 mm.Diameter, Small, Medium and Large. An irregular superior surface isprovided to conform to the soft tissue gingival architecture. Theinterproximal points will be longer in dimensions then the labial andlingual surfaces. The inner shell allows for the eccentric position ofthe shell over the center axis of the implant held within the bone.

Maxillary Left Lateral Central Incisor: Height 2 mm, Height 3 mm, thru 5mm. Diameter, Small, Medium and Large. An irregular superior surface isprovided to conform to the soft tissue gingival architecture. Theinterproximal points will be longer in dimensions then the labial andlingual surfaces. The inner shell allows for the eccentric position ofthe shell over the center axis of the implant held within the bone.

Maxillary Left Canine: Height 2 mm, Height 3 mm, thru 5 mm. Diameter,Small, Medium and Large. An irregular superior surface is provided toconform to the soft tissue gingival architecture. The interproximalpoints will be longer in dimensions then the labial and lingualsurfaces. The inner shell allows for the eccentric position of the shellover the center axis of the implant held within the bone.

It is understood that each shells 10 can be for the specific tooth beingreplaced. The dimensions of the shell are based on measurements ofnumerous soft tissue sockets remaining after tooth removal. The shell 10has the requirement to enable a soft tissue socket-seal to bere-established. This is predicated upon allowing the proper dimensionsto completely fill the soft tissue (tissue-zone) socket 100.

In general terms and from observation of stone casts and extracted teethas well as descriptions, pictures and illustrations in Dental Anatomybook, it seems that the “lingual valleys” are lower than “facialvalleys” in maxillary and mandibular incisors. Max. and mand. canines“valleys” are of about equal height. Max. and mand. premolars and molarsseem the opposite of incisors where “lingual valleys” are higher than“facial valleys” and mesial and distal peeks are not as highly scallopedas in incisors. Of course there are always exceptions and slightvariations to the rule since each person dental anatomy will vary.

These rules hold for a shell such as in FIGS. 1 to 8 for fabricating animmediate abutment, and for the marked shells of FIGS. 9 to 45.

The preferred embodiment of the hollow shell with orientation anddimensional markings and the immediate soft tissue implant preservationabutment shell is generally defined as a “tubular shell” which is openat both ends at perimeters 16 and 18. The inferior is placed into thesoft tissue socket 100 which does not make direct contact with theimplant head platform of the implant 30 within bone 106. The superiorsurface is to approximate the free-gingival margin of the surroundingtissue-zone. The outer surface of the shell 10 is to make direct contactwith the inner soft tissue residual socket 100. The final adapted shelleliminates all openings and gaps between the soft tissue socket andsurrounding gingival. This re-establishes a biologic-seal to theunderlying tissues below the surface. This will also provide containmentand protection of any bone regenerative materials that are placedbetween the surface of the bone socket and the surface of the implantfilling the “gap” between the dissimilar diameters of these twostructures.

The hollow marked shell 10 has one or more orientation markings on theocclusal surface of the hollow shell as seen FIGS. 12 to 18. Themarkings may be indents, detents, wings, tabs, laser etched markings,decals or the use of a single bar code can be used separate or incombination to the markings described. The markings provide the spatialorientation of the shell positioned within the residual soft tissuegingival socket. These “markings” can be detected by electronic scanningmeans or provide adequate physical identification that they can berecorded using an impression material commonly used in dentistry such aspolyether impressions, alginate impressions, rubber base impressions andthe like.

The preferred embodiment of marked connection post 40 with orientationand dimensional markings of FIGS. 19 to 35 and 45 that is affixed to aroot-from dental implant 30 is generally defined as a single post withthree sections; coronal section, vertical stop section and implantengagement section. The coronal section displaying unique markingsrepresented by indents, detents, wings, tabs, decals, laser etching,holes as well as a bar code label. The cross-sectional geometry of thecoronal section may be round, triangular, hexagon but not limited tothese shapes. A shape may be selected to allow a mechanical driver to beattached to the top for placement and removal. The coronal aspect of theconnection post can be designed with a groove or internal hex or openingto allow a transfer of the connection post using a finger or mechanicaldriver. The coronal section of the connection post may be smoothsurfaced, roughened or designed with undercuts that are staggered orcircumferential. The surface pattern may be designed to allow theadhesion of a material or materials. It is understood that materialsthat adhere to the surface could be become dislodged upon insertion andremoval of the connection post from the root-form implant. This wouldfacilitate using the connection post in combination with a temporaryabutment. It is also possible that an external sleeve is applied to theouter surface in a coaxial design to which materials can adhere to. Thecoronal section of the connection post may be designed with astress-breaker feature so that if the connection post exhibitsoverloading be it functional or mechanical the connection post willseparate at a pre-defined location. The stress-breaker feature wouldprevent damage or blockage of the root-form implant access hole bybreakage of the connection post at the level of the head of theroot-form implant platform.

The vertical-stop section of the connection post is designed asmechanical interference when inserting the post within the root-formimplant. This vertical-stop creates a defined length from the head ofthe implant platform to position of the unique markings enabling thespatial positioning of the root-form implant to be related or indexed tothe residual soft tissue gingival socket position. The shape of thevertical-stop may be round, hexagon, octagonal, slotted or othergeometric shape. The shape allows an instrument to engage the surfacefor removal of the connection post from the root-form implant. Thevertical-stop may also be represented by a transition in the surfacebetween threaded and non-threaded or a transition between differentdiameters to the width of the connection post.

The engagement section of the connection post is designed to provide astable fit within a root-form dental implant. This may be fixed to thedental implant via internal screw, frictional interference or othermeans of active fit between the connection post and the root-formimplant.

In the preferred embodiment electronic impression using a hand-heldscanning device which records the distinct markings and orientation ofthe hollow-shell relative to the dental implant connection post isperformed. In an alternative embodiment impression are taken usingphysical impression materials recording the markings on the hollowshell, dental implant connection post and surroundings tissues. Thisinformation can be used to fabricate a variety of implant prostheticcomponents to be used for the temporization and final fabrication of thefinal implant prosthesis, including but not limited to the abutment,crown, monolithic abutment/crown restoration and/or a variety ofcomponents to accommodate the placement of final restoration. It ispossible to achieve this without luting the two components of the hollowshell and the implant post connection. In one embodiment that patientstays in the office as a custom abutment is fabricated by transferringthe digital information to electronic Additive or Subtractive dentalfabrication machines, examples included but not limited to CAD/CADMilling machine, 3D printing, Stereolithographic, 3-D inkjet technologythat can immediately or rapidly fabricate a temporary abutment from avariety of acceptable dental materials.

In another embodiment a pre-treatment electronic or physical dentalimpressions is taken to relate the surrounding teeth and gingival to theprosthesis to be fabricated. It is also possible to take a pre-scan orpre-op impression so that the replication of the clinical crown of thetooth removed can be electronically or physically available for thefabrication of the prosthesis and its components. It is anticipated thatthat final monolithic prosthesis or multi-component prosthesis can befabricated that includes the abutment and the clinical crown fabricatefrom a suitable dental material, examples include, but limited to,zirconium oxide ceramic, resin or resin-ionomer, polymethyl methacrylate(PMMA), polyetheretherketone (PEEK), lithium disilicate, or zirconiumdioxide, ceramic of other durable material such as gold alloy, e.g.AuPdAg (gold-palladium-silver). An access screw hole is provided withinthe restorations for retention of the process directly to the dentalimplant.

In yet another embodiment the fabrication of multiple components such asa custom abutment that is screwed to the head of the dental implant isfabricated. The abutment allows the cementation of a clinical temporarythat can be fabricated at the chair side at the time of the surgery.What is of critical importance is the ability to capture that anatomicand spatial relationship of the residual soft tissue socket of the freshtooth extraction site using a hollow shell with orientation and shapeand size markings. This can be spatially related to the underlyingimmediate root-form implant through the use of a connection post withorientation and shape/size markings. This can be accomplished in spiteof the relative position of these two critical structures. Additionally,recording the relationship of the residual anatomy of the soft tissuegingival socket does not require physical contact of the hollow shell tothe underlying dental implant, nor does it require the physical contactto the dental implant post to capture and provide this information inthe fabrication of the prosthetic components.

The prosthetic components that are fabricated from the recordings of thespatial relationship of hollow shell and dental root form implant canplaced. Removal of both the hollow shell and the dental implantconnection post is performed. An immediately fabricated abutment isplaced into the patient mouth and secured (screw retained or cemented)to the underlying immediate dental implant. The custom abutment providesproper soft tissue seal and protection of the underlying residual softtissue socket. Yet another embodiment would allow the fabrication of atemporary clinical crown to be attached to the intervening customabutment that has been fabricated. Adequate time for osseo-intregrationof the dental implant is allowed.

In yet another embodiment the hollow shell with orientation markings andthe connection post markings is used to record the spatial relation ofthe residual soft tissue gingival socket to the underlying root-formimplant. The relationship is recorded by the means previously described.Fabrication of prosthesis components can be initiated. It is alsoanticipated that the surgeon may elect to record the relationship of thesoft tissue socket to the underlying root-form implant and then place aconventional healing cap affixed to the dental implant. The soft tissuewould heal without further consideration. The recorded relationshipcould be used to fabricate an abutment and or abutment and finalprosthesis and be placed at a later date. The advantage to this isapproach capturing the soft tissue anatomy prior to changes that aretypically seen during healing. At a subsequent time the fabricatedprosthesis components can be placed to re-establish the soft tissuecontours to the state prior to the removal of the tooth at that site.This enables a customized abutment to be fabricated and be placed with adelayed approach for the immediate implant placement into a freshextraction site.

The electronic data recordings described provide information that istransferred to the fabrication of a physical or electronic model (3-DCAD model as an example). These models then to serve to allow thefabrication of components that are to be used for dental implantprosthesis. The components to be fabricated include, but are not limitedto, implant abutment, implant crown, one piece monolithic implantabutment-crown. The fabrication of the dental implant prosthesiscomponents can be fabricated by CAD/CAM, additive or subtractiveautomated digitally machines, digital CAD milling machines and the like.

Once the hollow-shell with markings and the connection post withmarkings is used to record the spatial relationship of the residual softtissue gingival socket these components can be used to fabricate atemporary prosthesis as previously described. It is also possible thatthese components are removed and the placement of other temporaryabutment components is used.

Additionally, a membrane can be placed at the level of the bony crestand placement of the shell 10 will provide complete coverage of themembrane below providing a biologic-seal to the outer oral environment.Once the shell is filled (the luting step) and modified it will alsoprovide structural support to the soft tissue gingival to prevent andpreserve the architecture. The surface of the immediate abutment shellpromotes soft tissue adhesion to the surface. Allowing the superficiallayers of the dermis to adhere to a smooth superior region of theabutment shell as well as encouraging functional fiber orientation tothe roughened inferior region to promote a functional connective tissueattachment.

Luting (chair-side connection) of the immediate soft tissue implantpreservation abutment shell to the retaining screw-post of the implant:Once the proper abutment shell is selected from the variety of sizes anddiameters it is placed within the tissue-zone soft tissue socket. It iseccentrically positioned to the implant as previously described so thatthe outer surface of the shell make physical contact ensuring abiologic-seal between soft tissue and surface of the shell. It is lutedor connected to the screw-post in this position by using a chairsidetechnique. The technique of connecting the shell 10 to the screw-post 40can be performed with a variety of materials 60, in the preferredembodiment a cold-cure acrylic is used, in additional embodiments anynumber of polymerization materials can be used but not limited tocomposite, acrylic, resin, etc. The entire internal surface of the shell10 is filled with luting compound as shown in FIGS. 6 and 8, eliminatingvoids or gaps within the material.

The superior surface can be filled to the level of the free gingivalmargin. An access hole will remain to allow removal of the shell, e.g.but inserting a nylon plug 80 into the central hole of the post 40 asshown in FIG. 8, for final finishing and temporary insertion.

The inferior surface is modified and any gap or voids are filledchair-side and then re-surfaced as described below.

Re-surfacing of the shell material, preparation and handling: In certainsituations it may be necessary to modify the shape and surface of theshell 10 to properly adapt to the soft tissue socket 100. An additivetechnique of material or subtractive technique can be required in whichadditional materials or added or removed. To resurface the modifiedouter shell a novel surface texture bur is attached to a standard rotaryhandpiece. This preservation abutment shell bur is designed tore-establish the surface texture that was created in the texture zone onthe outer surface of the abutment shell. A second step of cleaning isthen required to ensure removal of all contaminants. This second surfacecleaning step is accomplished by thorough cleaning, in the preferredembodiment this can require high-pressure, high-heat steam cleaning inalternative embodiments it is anticipated that autoclave, antimicrobialcleaning solutions may be applied to the surface to detoxify thecontaminated surface.

After filling and reshaping of the shell 10 is completed it is removedfrom the implant by un-screwing the retaining screw 50. The abutmentshell is then cleaned and inspected and all voids are filled andre-surfaced and cleaned as described above.

Placement of a standard cylindrical healing abutment is attached to theplate-form. The standard cylindrical healing abutment may be composed oftitanium, stainless steel, anodized metal or other metal. It isconceivable that the standard cylindrical healing abutment is made froma cost saving polymer and disposed of after removal as this component isto be used as an intra-operative space maintaining during the placementof bone regenerative materials during this method. The standard healingabutment is selected to attach to the implant resulting with anoticeable gap between the outer surface of the standard cylindricalhealing abutment and the soft tissue socket. Bone grafting materials areplaced within the gap between the bony socket 102 and surface of theimplant 30 at or below the crest of bone. An optional barrier membranecan be positioned if necessary before or after the bone graftingmaterials being put into placed.

The standard cylindrical healing abutment is removed and discarded andthe contoured refinished abutment inserted. In the preferred embodimentthe retaining screw is put into placed and applying a seating torque tothe screw that is between 15 newton-centimeters to 35newton-centimeters.

The abutment shell 10 is adjusted to ensure that it is not in occlusalcontact with the opposing teeth 104 when the patient closes their mouth.

A final radiograph is taken to assess the fit and position of theimplant and shell.

The abutment shell 10 creates a biologic-seal to the underlying softtissue and preserve the integrity of the surrounding gingivalarchitecture. The abutment shell 10 is not to be removed for a minimumof 3-4 months at which time the fabrication of the final prosthesis canbe initiated.

Further Structural Details of the Invention:

As noted, illustrated and described above, abutment shell 10 in itspreferred form, is generally a tubular shell which is open at both ends.The tubular shell has the following specifications but it is anticipatedthat it may also have other designs features:

The shell is an irregular tubular design that mimics the shape ofresidual soft tissue (tissue-zone) socket 102 that remains after a toothhas been removed. Examples of these shapes (generally occlusal views)are provided in FIGS. 2-5. The shape may more closely mimic thecross-sectional outline of a root in the tissue-zone region, but mayalso be designed to over-compensate on one or more surfaces to ensurephysical contact along all aspects of the soft tissue tooth socket. Itis critical that the shell's fit with contact and not be causesexcessive contact pressure at any specific point or area of the softtissue socket.

Design of Markings of Hollow Shell and Connecting Post

Outline shape of the two ends of the preservation abutment shell 10 isirregular as also illustrated in the drawings. The superior (gingival)surface of the shell (at outer perimeter 18) has a larger area whencompared to the inferior (implant) surface (at inner perimeter 16) thatcomes into contact with the platform head of the implant 30.

The vertical height of the tubular shell will not be uniform. Theinterproximal surfaces at peaks 20 and 22 have a greater height whencompared to the buccal and lingual surfaces at 24 and 26 of the tubularshell 10.

The emergence profile of the shell is one that has a variety of profilesto compensate for the position of the implant within the residualsocket. Since the implant is to be intentionally placed off-center fromthe extracted tooth, the shell is intentionally placed eccentric to theimmediate implant 30, placed within the bone. The shell is designed tobe placed eccentric to the implant head. The emergence profile of theshell is over-compensated and under-compensated in the profile designallowing for the position of the implant. The compensating emergenceprofile design and ability to place the shell eccentric enables there-establishment of an effective biologic-seal between the outer surfaceof the shell and the residual soft tissue perimeter. The shell can beconfined to the transmucosal (tissue-zone) region extending from thecrest of bone to the free gingival margin or it may continue to extendinto the oral cavity as the labial surface of material to replace thelabial surface of the removed tooth in addition to the transmucosalregion.

Surface Texture of Shell—In the preferred embodiment the outer surfacetext design can possess two distinct surface texture regions. Thesuperior (gingival) surface region can be smooth to discourage theaccumulation of plaque. The superior smooth zone may extend 1 mm to 3mm. The inferior region will possess an ordered microgeometricrepetitive surface texture or pattern. The inferior textured regioncovers the remaining outer surface. This textured surface encourages there-establishment of the gingival fibers to make contact and adhere tothe surface of the temporary abutment. The surface texture is notlimited to two or more texture patterns, it is conceivable that thesurface of the shell be design with a single texture covering the entiresurface or designed from multiple textures to encourage direct softtissue adaptation within the tissue-zone. A smooth surface at thesuperior regions discourages plaque accumulation while the texturedsurface promotes and accelerates effective soft tissue adhesion. Thesurface design discussed in the preferred embodiment has been shown topromote soft tissue preservation in combination with providing aneffective biologic-seal of the surface of the shell to the residual softtissues.

The hollow shell with distinct identification and orientationindications or markings upon the hollow shell as shown in FIG. 12-18.The markings may be of a design of physical markings, such as holes,grooves, geometric spaces, indents, detents, internal or external tabsor wings and/or visual markings, laser etching, decals, colored markingsor other means of recording spatial orientation of the hollow shell andit's relationship to the residual soft tissue gingival socket. Themarkings will also code for the physical shape and dimensions of thehollow shell selected for use.

The connection post 40 for the root-form dental implant (FIGS. 19-35)with distinct identification and orientation indications upon theconnection post. The markings may be of a design of physical markings,such as holes, grooves, geometric spaces, indents, detents, internal orexternal tabs or wings and/or visual markings, laser etching, decals,colored markings or other means of recording spatial orientation of theconnection post and its relationship to the root-form dental implant.The markings will also code for the physical shape and dimensions of theconnection post selected for use. The connection post may be retained bya variety of means including but not limited to screw, frictionalinterface, etc.

The shell can be composed of a variety of biocompatible materialsincluding but not limited to; ceramic, acrylic, porcelain, lithiumdisilicate, zirconia and other crystalline structure. It is anticipatedthat this material can be composed of materials that are anti-microbial,bacteriostatic to retard the growth or colonization of the surface andinternal surfaces with micro-organisms. Examples of such materialsinclude but are not limited to; silver, copper, magnesium, titanium,hydroxyapatite, etc. These materials can be incorporated into the shellmaterial or may be applied to the shell surface forming a second layer.

Material of the connection post can be composed of a variety ofbiocompatible materials including but not limited to; aluminum,stainless steel, gold, titanium, titanium alloy, or other less preciousmetals can be uses for the temporary post, ceramic, acrylic, porelian,lithium desilicate, zirconia and other crystalline structure. It isanticipated that this material can be composed of materials that areanti-microbial, bacterior static to retrard the growth or colonizationof the surface and internal surfaces with micro-organisms. Examples ofsuch materials include but not limited to; silver, copper, magnesium,titanium, hydroxyapitite, etc.

The connection interface between the abutment shell is placed at thelevel the implant head platform. In the preferred embodiment there is asingle interface at the implant plate-form at the bone crest level. Thisinterface is a mechanical connection to minimize the placement of amicro- or macro-connection gap within the tissue-zone. The preferredembodiment is screw-retained. It is anticipated that a cementableversion of the immediate soft tissue implant preservation abutment shellcan be fabricated.

The preferred embodiment of the shell is confined to the tissue-zone,but it is anticipated that a second design could include part of all ofthe tooth form that was extracted.

As shown in FIG. 8, the tooth-form temporary 70 that is selected orcreated to match the extracted tooth, is then luted to the outerperimeter 18 of shell 10 so that the patient leaves with a cosmeticallyequivalent tooth replacement to the one extracted.

Disposable Standard Cylindrical Implant Intra-operative Abutment: Thiscomponent is used as intra-operative abutment that is placed during theimmediate soft tissue implant preservation protocol to allowing bonegrating materials to be placed within the bone gap between the implantsurface and the bony residual socket. It also has the function toprevent bone grafting materials from entering into the internal screwhole of the implant prior to the placement of the immediate soft tissueimplant preservation abutment. It is a single use, disposable component.It can be fabricated from a variety of materials and come in a varietyof heights and widths. The preferred embodiment is an inexpensivepolymer material allowing it to be screwed or press-fitted into placeduring the placement of the bone grafting materials.

Immediate soft tissue Abutment Texturing Bur: This component is a rotarybur that is designed to provide a microgeometric repetitive surfacepattern forming a varying widths and varying depths ranging from 10microns to about 50 microns. The irregular repetitive pattern is createdusing a chair-side rotary instrument on the surface of the immediatesoft tissue implant preservation abutment to resurface the outer shell.

Some Improvements Over Prior Art:

Following are some improvements of the invention over known implantapparatuses and methods.

Preservation of the soft tissue architecture after the immediate removalof a tooth.

Ability to record the spatial relationship of the soft tissue residualgingival socket to the spatial position of the underlying root-formdental implant irrespective of the x, y, z axes relationship of thesetwo independent structures. The non-concentric relationship is easilyrecorded and allows for the fabrication of a variety of prostheticcomponents to be used.

Provide a means to fabricate an immediate abutment or other prostheticcomponents using orientation markings and structural dimensions of therecording components. These components then enable the fabrication ofdissimilar spatial positions to be recorded for custom fabrication ofprosthetic components relationship soft tissue contours to theunderlying root-from implant.

Support of the soft tissues to prevent collapse of bone and soft tissueduring healing.

Creation a soft tissue “seal” of the replacement temporary to theoverlying soft tissues. A soft tissue seal of the residual soft tissuesocket of an extracted tooth in which an immediate implant has beenplaced.

Produce soft tissue adhesion by providing direct physically contactbetween the prosthesis and surrounding soft tissue socket.

Placement of a single interface between implant and prosthesis that isbelow the soft tissue proximal heights at or below the level ofsupporting bone.

One-piece prosthetic design that is a temporary that is screw retained.

Prosthesis emergence profile is over-contoured to provide an adequatesoft tissue seal and soft tissue support to the soft tissues to preservethe natural architecture of the gingival tissues.

Prosthesis is under-contoured to provide an adequate soft tissue sealbetween prosthesis and soft tissue socket to support the soft tissues topreserve the natural architecture of the gingival tissues.

The supra-gingival contour of the tooth prosthesis is identical to thenatural tooth while the sub-gingival possesses a emergence profilecontour that is either over-contoured or under-contoured to compensatefor the lack of ideal position of an implant in the vertical,horizontal, and buccal-lingual, mesial-distal angulations.

Anti-rotational prosthesis screw-retained temporary prosthesis.Anti-rotational features in the implant/abutment connection.

The temporary abutment is constructed directly chair-side utilizing aprefabricated series of anatomic shells who's central access iseccentric to allow either an over-contoured or under-contouredsubgingival emergence profile thereby allowing adequate support of thesoft tissue and ensuring a seal being formed between the soft tissuesocket and the temporary prosthesis.

The temporary abutment is anticipated to prefabricate in a variety ofsizes and elliptical shapes of the root surfaces. Different verticalheights will be provided. The shapes will be designed to representreplacement of an extracted tooth.

Antimicrobial Surface and/or material to be used.

Incorporation of a microtexture on the surface of the temporary that hasa regular geometric configuration to encourage soft tissue connection.

Use of a specialized bur that creates a regular pattern on the surfaceof the temporary.

The following designs are anticipated, but not limited to:

Temporary transmucosal (root form) implant temporary shell root form inthe soft tissue zone from the platform head of the implant to thefree-gingival margin.

The superior 1-3 mm may be smooth surfaced to provide a plaque freezone.

Inferior surface (below the 1-3 mm plaque zone) may be textured toencourage soft tissue adhesion.

Surface treatment of the shell by steam cleaning.

The transmucosal temporary component of the invention makes the physicaland structural connection between the dental implant and the overlyingsoft tissues for the final connection to a tooth replacement prosthesisvisible inside the mouth.

The implant 30 and screw 50 are made of surgical steel or other metalssuch as titanium/titanium alloy. The post is made of steel, ceramic ofother durable material such as gold alloy, e.g. AuPdAg(gold-palladium-silver). The shell is zirconium oxide ceramic or othersuitable material as listed above. The luting compound is, for exampleresin or resin-ionomer. The tooth-form temporary 70 is made of materialsuch as polymethyl methacrylate (PMMA), polyetheretherketone (PEEK),lithium disilicate, or zirconium dioxide.

While specific embodiments of the invention have been shown anddescribed in detail to illustrate the application of the principles ofthe invention, it will be understood that the invention may be embodiedotherwise without departing from such principles.

What is claimed is:
 1. A soft tissue preservation, dental implantarrangement, comprising: a hollow shell (10) with an interior volume anda shell axis (12), the hollow shell having an outer surface for engaginga soft tissue socket that is left in gingival tissue immediately after atooth has been extracted from a bone socket under the gingival tissue,the shell having a first perimeter (16) adapted for placement toward thebone socket and a second perimeter (18) adapted for placement adjacentan outer surface of the gingival tissue around the soft tissue socket,the first perimeter being smaller than the second perimeter so that theshell tapers outwardly from the first to the second perimeters, thesecond perimeter being asymmetrically scalloped with opposite distal andmesial peaks (20, 22) and opposite lingual and facial valleys (24, 26)between the peaks, and the shell being sized for closely engagingagainst the soft tissue socket without gaps; a dental implant (30)having an implant axis (32) and being adapted for placement in the bonesocket; and a temporary post (40) rigidly connected to and coaxial withthe dental implant, the temporary post extending in the interior volumeof the hollow shell, a minimum inside diameter of the hollow shell (10)being larger than a maximum outside diameter of the post and no part ofthe shell being in contact with any part of the post despitenon-alignment of the shell axis (12) with the implant axis (32) and sothe shell is at its own position and orientation as dictated by the softtissue socket and has an independent position with respect to the postthat is at its own orientation as dictated by the boney socket when theouter surface of the shell engages against the soft tissue socketwithout gaps and without requiring alignment of the shell axis (12) tothe implant axes (32) and with freedom of relative position and anglebetween the shell and the post.
 2. The arrangement of claim 1, whereinthe lingual valley (24) is at a different height above the firstperimeter (16) then the facial valley (26).
 3. The arrangement of claim1, including a luting compound (60) filling the interior volume betweenthe shell and the temporary post and setting solid for fixing the shellto the dental implant so that the post (40), the shell (10) and theluting together form an abutment for the soft tissue socket, the hollowshell (10) having an outer bio-compatible surface for engaging the softtissue socket.
 4. The arrangement of claim 1, wherein the post (40) andthe shell (10) each include at least three spaced markings, the markingson the shell being on an inside surface of the shell and the markings onthe post being on an outside surface of the post, the markings creatingcorresponding markings on an image of the post and shell when the postis connected to the implant and when the shell is in the soft tissuesocket for recording data in the image corresponding to the relativeposition and angle between the shell and the post for use in creating atleast one of an abutment and a crown for the soft tissue socket.
 5. Thearrangement of claim 1, wherein the distal and mesial peaks are not in acommon plane with the shell axis.
 6. The arrangement of claim 1, whereinthe post (40) and the shell (10) each include at least three spacedmarkings, the markings on the shell being on an inside surface of theshell and the markings on the post being on an outside surface of thepost, the markings creating corresponding markings on an image of thepost and shell when the post is connected to the implant and when theshell is in the soft tissue socket for recording data in the imagecorresponding to the relative position and angle between the shell andthe post for use in creating at least one of an abutment and a crown forthe soft tissue socket, the markings on the shell include informationabout the size and shape of the shell and the markings on the postincluding information about the depth of the implant in the boneysocket.
 7. The arrangement of claim 1, wherein the post has an uppercoronal portion for extending in the shell and a lower threaded portionfor being treadably connected to the implant, at least part of thesurface of the coronal portion being roughened and having at least oneundercut, the post including at least one large diameter portion that islarger than the threaded portion for fixing the axial location of thepost to the implant.
 8. The arrangement of claim 1, wherein the post hasan upper coronal portion for extending in the shell and a lower threadedportion for being treadably connected to the implant, the coronalportion having a breakaway portion and at least one large diameterportion that is larger than the threaded portion for fixing the axiallocation of the post to the implant.
 9. The arrangement of claim 1,including a luting compound (60) filling the interior volume between theshell and the temporary post and setting solid for fixing the shell tothe dental implant so that the post (40), the shell (10) and the lutingtogether form an abutment for the soft tissue socket, and a tooth-formtemporary (70) attached at the second perimeter (18) for temporarilyreplacing an extracted tooth.
 10. The arrangement of claim 1, includinga luting compound (60) filling the interior volume between the shell andthe temporary post and setting solid for fixing the shell to the dentalimplant so that the post (40), the shell (10) and the luting togetherform an abutment for the soft tissue socket, the hollow shell (10)having an outer bio-compatible surface for engaging the soft tissuesocket, a the screw (50) extending in the post (40) and connecting thepost to the implant (30), and a plug (80) in the post (40) above thescrew and in the luting compound (60) for providing access to the screwwhen the plug is removed for disconnecting the post from the implant.11. A dental restoration method comprising: dissecting attachment of atooth to be extracted from soft tissue around the tooth to create a softtissue socket (100); extracting the tooth to leave a bone socket (102)and the soft tissue socket (100); preparing the bone socket (100) forimmediately receiving an implant (30); immediately after preparing thebone socket, fixing an implant (30) into the bone socket (102);connecting a post (40) to the implant (30); selecting an immediate softtissue implant preservation shell (10) that has an outer shape anddimensions that substantial match the soft tissue socket; and placingthe shell (10) into the soft tissue socket (100) outwardly of theimplant (30) to form a biological seal without gaps with the soft tissuesocket, the shell not being connection to the implant so that an outersurface of the shell engages against the soft tissue socket without gapsand without requiring alignment or fixed relative positioning betweenthe shell and the implant, the post extending in the interior volume ofthe hollow shell with a minimum inside diameter of the hollow shell (10)being larger than a maximum outside diameter of the post so that no partof the shell comes into contact with any part of the post despitenon-alignment of the shell axis (12) with the implant axis (32) and sothat here is no mechanical connection between the shell and the implantwhen the outer surface of the shell engages against the soft tissuesocket without gaps and without requiring alignment of the shell axis(12) to the implant axes (32) and with freedom of relative position andangle between the shell and the post.
 12. The dental restoration methodof claim 11, including selecting the implant to be fixed in the bonesocket to have a diameter that is less than a maximum diameter of thebone socket so that a gap is left between the implant and at least anouter part of the bone implant for receiving bone regenerative material.13. The dental restoration method of claim 11, including, after placingthe shell (10) and after connecting the post (40), filling a volumebetween an inner surface of the shell (10) and an outer surface of thepost (40) with a luting compound and allowing the luting compound tosolidify to fix the shell to the post and implant.
 14. The dentalrestoration method of claim 11, wherein the shell includes at leastthree spaced markings on an inside surface thereof and the post includesat least three spaced markings on an outside surface thereof, the methodincluding optically scanning the shell and post for recording an imageof the shell and post and their markings when the post is connected tothe implant and when the shell is engages to the soft tissue socket forcollecting data, the markings creating corresponding markings on animage of the post and shell when the post is connected to the implantand when the shell is in the soft tissue socket for recording data inthe image corresponding to the relative position and angle between theshell and the post for use in creating at least one of an abutment and acrown for the soft tissue socket, the markings on the shell includeinformation about the size and shape of the shell and the markings onthe post including information about the depth of the implant in theboney socket.
 15. The dental restoration method of claim 11, includingfixing a tooth-form temporary (70) to the outer perimeter of the shellto temporarily replace the extracted tooth.
 16. The dental restorationmethod of claim 11, wherein the post has an upper coronal portion forextending in the shell and a lower threaded portion for being treadablyconnected to the implant, at least part of the surface of the coronalportion being roughened and having at least one undercut, the postincluding at least one large diameter portion that is larger than thethreaded portion for fixing the axial location of the post to theimplant.
 17. The dental restoration method of claim 11, wherein the posthas an upper coronal portion for extending in the shell and a lowerthreaded portion for being treadably connected to the implant, thecoronal portion having a breakaway portion and at least one largediameter portion that is larger than the threaded portion for fixing theaxial location of the post to the implant.
 18. The dental restorationmethod of claim 11, wherein the post has an upper coronal portion forextending in the shell and a lower threaded portion for being treadablyconnected to the implant, the coronal portion having at least one largediameter portion adjacent the treaded portion, the method includingscrewing the threaded portion into the implant until the large diameterportion engaged a top of the implant for fixing the height of the postabove the implant.
 19. The dental restoration method of claim 11,wherein the shell includes at least three spaced markings on an insidesurface thereof and the post includes at least three spaced markings onan outside surface thereof, at least one of the markings of each of thepost and shell projecting out from the surface of the post or shell andat least one of the markings of each of the post and shell being cutinto the surface of the post or shell.
 20. The dental restoration methodof claim 11, wherein the shell includes at least three spaced markingson an inside surface thereof and the post includes at least three spacedmarkings on an outside surface thereof, the method including opticallyscanning the shell and post for recording an image of the shell and postand their markings when the post is connected to the implant and whenthe shell is engages to the soft tissue socket for collecting data, themarkings creating corresponding markings on an image of the post andshell when the post is connected to the implant and when the shell is inthe soft tissue socket for recording data in the image corresponding tothe relative position and angle between the shell and the post for usein creating at least one of an abutment and a crown for the soft tissuesocket, the markings on the shell include information about the size andshape of the shell and the markings on the post including informationabout the depth of the implant in the boney socket, and fabricating atleast one of an abutment and a crown using the data and the informationfor accurately fitting the abutment or crown to the soft tissue socketwithout gaps.